亚甲基四氢叶酸还原酶基因多态性对胃癌化疗患者治疗疗效及预后的影响

Effect of MTHFR Gene Polymorphism on Chemotherapy Efficacy and Prognosis in Patients with Gastric Cancer

目的探讨亚甲基四氢叶酸还原酶(MTHFR)基因多态性对胃癌化疗患者治疗疗效及预后的影响。方法选取2016年1月—2018年12月期间洛阳市中心医院收治的300例胃癌患者,抽取静脉血进行基因检测,根据结果将其分为A、B、C、D四组;使用5-氟尿嘧啶(5-FU)和卡培他滨药物化疗,观察比较不同基因型患者治疗疗效及不良反应情况。结果DPD酶活性低且MTHFR基因发生C-T突变共72例(24.00%);DPD酶活性低且MTHFR基因未发生C-T突变共76例(25.33%);DPD酶活性高且MTHFR基因发生C-T突变共74例(24.67%);DPD酶活性高且MTHFR基因未发生C-T突变共78例(26.00%)。A组、B组、C组、D组化疗有效率分别为54.17%、39.47%、40.54%、32.05%;A组有效率高于B组、C组、D组(P<0.05)。A组、B组、C组、D组不良反应发生率分别为20.83%、47.37%、52.70%、71.79%;A组不良反应发生率低于B组、C组、D组(P<0.05)。结论通过检测胃癌患者体内DPD酶活性及MTHFR基因多态性,预测不同基因型患者化疗药物敏感性及耐受性,在疾病初期为患者制定个体化给药方案,可有效提高治疗有效率并减少不良反应,预后较好,值得推荐。

Objective To investigate the effect of methylenetetrahydrofolate reductase MTHFR gene polymorphism on chemotherapy efficacy and prognosis in patients with gastric cancer.Methods 300 patients with gastric cancer admitted to the hospital from January,2016 to December,2018 were selected.Venous blood was extracted for genetic testing.Based on the results,patients were divided into group A,group B,group C and group D.All patients underwent hemotherapy with 5-fluorouracil(5-fu)and capecitabine.The therapeutic effect and adverse reactions of different genotypes were compared.Results There were 72 cases(24.00%)with low DPD activity and MTHFR gene C-T mutation,76 cases(25.33%)with low DPD activity and MTHFR gene without C-T mutation,as well as 74 cases(24.67%)with high DPD activity and MTHFR gene C-T mutation.The effective rates of chemotherapy in group A,B,C and D were 54.17%,39.47%,40.54%and 32.05%,respectively,which was the highest in group A(P<0.05).The incidence rates of adverse reactions in group A,B,C and D were 20.83%,47.37%,52.70%and 71.79%respectively,which was the lowest in group A(P<0.05).Conclusion Detection of DPD enzyme activity and MTHFR gene polymorphism in gastric cancer patients can predict the sensitivity and tolerance of chemotherapy drugs in patients with different genotypes,so that individualized drug delivery plans can be developed for patients at the early stage of the disease,which can effectively improve the treatment efficiency and reduce adverse reactions,and have a good prognosis.So it is worth recommendation.