胃癌外周血及胃左静脉血sTNFR Ⅱ检测及其临床意义

The measurement and clinical significance of soluble tumor necrosis factor recpetor Ⅱ (sTNFR Ⅱ ) in peripherial vein and left gastric vein of gastric cancinoma

目的探讨胃癌患者血清中可溶性肿瘤坏死因子受体 Ⅱ（ｓＴＮＦＲⅡ）的水平及临床意义。方法应用Ｅｌｉｓａ方法检测 ３９例胃腺癌患者术前、术后 １４天外周血及术中胃左静脉血ｓＴＮＦＲⅡ水平，并以正常献血员作正常对照组。所有病例术后随访 １年以上。结果（１）胃癌外周血及胃左静脉血ｓＴＮＦＲⅡ均高于正常对照组；且胃左静脉血ｓＴＮＦＲⅡ明显高于外周静脉血；（２）术前外周静脉血ｓＴＮＦＲⅡ水平与肿瘤大小、肿瘤侵犯深度、有否淋巴结转移及远处转移、ＵＩＣＣ分期、肿瘤分化程度无关；胃左静脉血ｓＴＮＦＲ Ⅱ水平在肿瘤侵出或侵犯浆膜、有远处转移及肿瘤低～未分化组明显高于肿瘤局限于肌层或粘膜内、无远处转移及高～中分化腺癌者；（３）随访期间复发或死亡１８例，健在组 ２１例术中胃左静脉血及术后 ２周外周静脉血ｓＴＮＦＲⅡ明显低于复发或死亡组。结论胃癌患者存在高水平的 ｓＴＮＦＲⅡ．且肿瘤的引流静脉存在更高水平的 ｓＴＮＦＲⅡ，在肿瘤累及浆膜时其增高更加明显。显示肿瘤坏死因子可能在其生成的局部发挥短程作用；术后仍维持较高水平ｓＴＮＦＲⅡ者常提示预后不良。

Objective To study the clinical significance of serum soluble tumor necrosis factor recptor Ⅱ in gastric carcinoma. Methods The levels of sTNFR Ⅱof periphery vein and left gastric vein were analyzed with ELISA method in 39 patients with gastric cancer before and after gastrectomy. All patients were followed up for more than one year after operation. Results The levels of sTNFR Ⅱ in gastric cancer were higher than those in control group. In gastric carcinoma the serum sTNFR Ⅱ was higher in left gastricv vein than in peripherial vein significantly. The levels of sTNFR Ⅱ in peripherial vein before operation were not related to tumor size,invasive depth,lymph node and distance metastasis,UICC stage and histological differentiation. The concentration of sTNFRⅡ in left gastric cancinoma was significantly higher in patients with serosa invasive,poor differentiation or metastasis than that in patients with no serosa invasive,well differentiation or no metastasis. During the period of follow-up 18 patients had recurrence or died. In survival patients the serum sTNFR Ⅱ levels of left gastric vein and postoperation peripherial vein were significantly lower than those in recurrent or fatal patients. Conclusion Patients with gastric carcinoma have a hgih level sTNFR Ⅱ and the levels of sTNFR Ⅱ in tumor drain vein are significantly higher than those in peripheral veins,suggesting that tumor necrosis factor might play a role in short rang in its productive position. High serum sTNFR Ⅱ level is a poor prognostic factor.