非小细胞肺癌胸腔镜与常规开胸术后血清VEGF、MMP-9变化的研究

Changes in Serum Vascular Endothelial Growth Factor and Matrix Metalloproteinase-9 After Video-assisted Thoracoscopic Surgery and Thoracotomic Lobectomy in the Treatment of Patients with Non-small Cell Lung Cancer

背景与目的血管内皮生长因子(vascular endothelial growth factor,VEGF)及基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)是重要的促血管生成因子,它们在肺癌血管生成中起着非常重要的作用。本研究旨在探讨非小细胞肺癌(non-small cell lung cancer,NSCLC)患者围手术期血清VEGF及MMP-9水平变化的规律,同时比较电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)及常规开胸手术(traditional open surgery,TOS)后上述指标变化的差异。方法选取卫生部北京医院胸外科2010年10月-2012年8月收治的NSCLC患者43例,入组患者均在全麻下行肺叶切除、系统淋巴结清扫术,所有患者均于术前1天、术后第1、2、3、7天抽取静脉血测定血清VEGF及MMP-9的水平,观察围手术期两指标的变化规律。根据手术方式的不同将入组患者分为胸腔镜组(VATS组,25例)及常规开胸组(TOS组,18例),比较两组围手术期血清VEGF及MMP-9变化的差异。结果 NSCLC患者术后血清VEGF及MMP-9水平均呈先升高后下降的趋势,分别于术后第2天、第3天达到峰值浓度,与术前相比有明显统计学差异(P=0.031,P=0.020),术后第7天时,两者水平仍高于术前。VATS组和TOS组两组术后VEGF及MMP-9水平也均出现先升高后下降的变化规律,变化幅度以TOS组明显,但两组间两指标变化趋势的差异均无统计学意义(F=2.022,P=0.163;F=1.703,P=0.199)。结论 NSCLC患者术后早期均出现血清VEGF及MMP-9水平的升高,变化幅度以TOS组略明显,但VATS与TOS组间的差异无统计学意义。

Background and objective Vascular endothelial growth factor （VEGF） and matrix metalloprotein- ase-9 （MMP-9） are important factors in angiogenesis. These factors function in the angiogenesis of lung cancers. The aim of this study is to determine the changes in serum VEGF and MMP-9 after patients with NSCLC were subjected to lobectomy. The aim of this study is also to compare the differences in the changes observed between video-assisted thoracoscopic surgery （VATS） and traditional open surgery （TOS）. Methods A total of 43 consecutive patients with NSCLC were recruited from October 2010 to August 2012. All of these patients underwent lobectomy and systematic mediastinal lymphadenectomy. Blood was drawn from these patients to measure the serum levels of VEGF and MMP-9 in the morning before surgery and on postoperative days 1, 2, 3, and 7 （POD1, POD2, POD3, and POD7, respectively）. Perioperative variations in serum VEGF and MMP-9 were also observed. Using different surgical options, we divided the patients into two groups： VATS group （25 patients） and TOS group （18 patients）.the differences in the changes in serum VEGF and MMP-9 were then compared be- tween the two groups. Results After surgery, the serum VEGF and MMP-9 of patients with NSCLC initially increased and subsequently decreased. The peak levels were observed on POD2 and POD3, and these levels were significantly higher than the preoperative levels （P=0.031, P=0.020）. On POD7, the serum VEGF and MMP-9 remained higher than the preopera- tive levels. In VATS and TOS groups, the serum VEGF and MMP-9 levels also initially increased and subsequently decreased. The TOS group showed a more evident variation. However, no significant statistical differences in the changes of VEGF and MMP-9 were found between the two groups （F=2.022, P=0.163; F=1.703, P=0.199）. Conclusion Serum VEGF and MMP-9 remarkably increase in TOS group and VATS group. Although the serum level of VEGF an MMP-9 in TOS group were higher than that in VATS group. But no significant difference was observed between VATS and TOS group.