恶性胸腔积液端粒酶活性与患者总生存期的相关性

Correlation between telomerase activity and overall survival in patients with malignant pleural effusion

目的探讨恶性胸腔积液患者的端粒酶活性与总生存期之间的相关性。方法前瞻性收集2015年12月1日至2017年12月31日韶关市粤北人民医院呼吸内科收治的腺癌性胸腔积液(腺癌组)、鳞癌性胸腔积液(鳞癌组)、小细胞癌性胸腔积液(小细胞癌组)患者各20份的胸腔积液标本及其临床资料,采用ELISA法分别检测胸腔积液标本中的端粒酶活性,方差分析LSD法比较三组标本的端粒酶活性,采用生存分析KM法比较三组患者的总生存期(overall survival,OS),采用Pearson相关分析考察端粒酶活性与患者总生存期之间的相关性。OS定义为从诊断到患者死亡。结果腺癌组、鳞癌组和小细胞癌组患者胸腔积液的端粒酶活性分别为198.8±23.9、196.9±7.9和210.5±6.9,小细胞癌组胸腔积液端粒酶活性明显高于腺癌组和鳞癌组,差异均有统计学意义(P<0.05),而腺癌组和鳞癌组患者的胸腔积液端粒酶活性比较差异无统计学意义(P>0.05);小细胞癌组患者的中位OS为(1.4±0.03)个月,明显短于腺癌组的(2.9±0.09)个月及鳞癌组的(3.0±0.12)个月,差异均有统计学意义(P<0.05),而腺癌组及鳞癌组患者的中位OS比较差异无统计学意义(P>0.05);胸腔积液端粒酶活性与患者总生存期呈中度负相关性(r=-0.54,P<0.05)。结论小细胞癌性胸腔积液患者总生存期短于鳞癌及腺癌患者,其端粒酶水平高于腺癌及鳞癌性胸腔积液端粒酶水平。恶性胸腔积液患者的不良预后可能与胸腔积液端粒酶活性水平相关,采取控制胸腔积液端粒酶水平的治疗方案可能改善恶性胸腔积液患者的预后。

Objective To investigate the correlation between the activity of telomerase and overall survival(OS) in patients with malignant pleural effusion. Methods Pleural effusion samples were collected from 20 patients with adenocarcinoma, 20 patients with squamous cell carcinoma, and 20 patients with small cell carcinoma from Dec. 1,2015 to Dec. 31, 2017 in Department of Respiratory Medicine, Yuebei People’s Hospital. Telomerase activity in the pleural effusion samples of the three groups were detected with enzyme-linked immunosorbent assay(ELISA) and then compared with one-way analysis of variance(ANOVA) among the three groups. The OS of these groups were analyzed with Kaplan Meier method. The correlation between the activity of telomerase and OS were analyzed with Pearson correlation analysis. OS were defined as from the diagnosis to death. Results Telomerase activity in pleural effusion of adenocarcinoma group, squamous cell carcinoma group, and small cell carcinoma group were 198.8 ± 23.9, 196.9 ± 7.9, and 210.5 ± 6.9 respectively, which was significantly higher in small cell carcinoma group than adenocarcinoma group and squamous cell carcinoma group(P<0.05) but showed no significant difference between adenocarcinoma group and squamous cell carcinoma group(P>0.05). The median OS of small cell carcinoma group was(1.4±0.03) months, significantly shorter than(2.9±0.09) months of adenocarcinoma group and(3.0±0.12) months of squamous cell carcinoma group(P<0.05). There was no significant difference in OS between adenocarcinoma group and squamous cell group(P>0.05).Telomerase level in pleural effusion was moderately negatively correlated with OS(r=-0.54, P<0.05). Conclusion The OS of patients with pleural effusion in small cell carcinoma is shorter than that of patients in squamous cell carcinoma and patients in adenocarcinoma pleural effusion, while telomerase level of patients with small cell carcinoma pleural effusion is higher. The poor prognosis of patients with malignant pleural effusion is correlated to the level of telomerase, and the treatment of controlling telomerase may improve the prognosis of patients with malignant pleural effusion.