胃癌患者外周血微转移的细胞学检测

The cytological examination of cancer cells in the peripheral blood of patients with gastric cancer

目的 肿瘤的浸润和转移是影响患者预后的重要因素 ,而肿瘤转移大多通过淋巴及血循环播散。为此该文研究建立胃癌患者外周血微转移癌细胞的细胞学检测方法并探讨其临床意义。方法 取进展期胃癌患者外周静脉血 5ml,经Ficoll液密度梯度离心及免疫磁珠法 (磁珠采用细胞角蛋白 7和细胞角蛋白 8包被 )分离出单核细胞 ,然后对细胞涂片进行苏木精 伊红染色观察 ;并采用免疫荧光染色和免疫细胞化学法检测癌胚抗原、人端粒酶逆转录酶、CD3 4 和CD45,对其中的胃癌细胞进行生物学特性分析。结果 在 2 4例胃癌患者的外周血中有 10例找到了癌细胞 ,阳性率为 4 1.7% ;癌细胞的检出与肿瘤原发灶的病理分级差异有显著性 (P <0 .0 5 )。结论 应用Ficoll密度梯度离心和免疫磁珠分选技术在胃癌患者的外周血中可分离检测到癌细胞 ,并可据此拟定治疗方案并对患者的预后作出判断。

Objective The infiltration and micrometastasis of cancer cells via lymph vessel and blood is the important factors which influence the prognosis of patients with cancer. The present study was to establish the method of cytological examination of circulating gastric cancer cell in the peripheral blood and to explore its clinical significance. Methods The monocytes in blood samples, taken from 24 patients with advanced gastric cancer, were seperated by using Ficoll density gradient centrifugation and magnetic cell sorting system in which the magnetic microbeads were wrapped with cytokeratin 7 and 8. The samples were smeared and observed with HE stain. The expression of CD 34 , CD 45 , CEA and human telomerase reverse transcriptase (hTERT) of the cells were also examined with immunocytochemical and immunofluorescence staining methods. Results Gastric cancer cells were found in 10 out of 24 cases, and the positivity rate was 41.7%, which was significantly different from pathological differentiation of primary focus. Conclusion This method can be used to detect cancer cells from peripheral blood of patients with gastric cancer and therapeutic protocol and prediction of prognosis can be made based on it.