围术期应用华蟾素对食管胃结合部腺癌患者行纳米碳淋巴结示踪根治术预后及HKDC1、ANXA13蛋白表达的影响

Based on serological HKDC1,ANXA13 analysis of the prognosis of patients with adenocarcinoma of oesophagogastric junction

目的:围术期应用华蟾素对食管胃结合部腺癌患者行纳米碳淋巴结示踪根治术预后及HKDC1、ANXA13蛋白表达的影响。方法:选取2018年1月—2020年12月在浙江中医药大学附属江南医院和延安大学附属医院接受食管胃结合部根治术治疗的80例患者,依据治疗手段的不同分为纳米组和蟾蜍素组,每组40例。纳米组患者给予切除术+纳米碳示踪淋巴结清扫术治疗,蟾蜍素组围术期应用华蟾素注射液结合切除术+纳米碳示踪淋巴结清扫术治疗。比较两组患者淋巴结检出数、肿瘤标志物水平、凝血功能、术后病理分期及HKDC1、ANXA13蛋白表达情况。结果:蟾蜍素组患者总淋巴结数、靶区淋巴数、周围淋巴数均低于纳米组(P<0.05)。蟾蜍素组糖类抗原19-9(CA19-9)、癌胚抗原(CEA)、糖类抗原125(CA125)、神经元特异性烯醇化酶(NSE)水平均低于纳米组(P<0.05)。蟾蜍素组凝血功能优于纳米组(P<0.05)。与治疗前比,治疗后两组患者胰岛素样生长因子结合蛋白(IGFBP)-3均升高,circAGFG1降低,且蟾蜍素组改善幅度更大(P<0.05)。术后T分期方面,蟾蜍素组pT0~2期18例,pT3~4期22例;纳米组pT0~2期1例,pT3~4期39例,两组比较存在明显差异(χ^(2)=19.948,P<0.001),术后N分期无明显差异(P>0.05);蟾蜍素组和纳米组的HKDC1阳性表达率分别为42.5%(19/40)、70.0%(28/40),蟾蜍素组低于纳米组(χ^(2)=4.718,P=0.040);两组ANXA13的阳性表达率无明显差异(P>0.05)。结论:华蟾素可在不影响其他各项手术指标的情况下有效提高食管胃结合部腺癌患者给予纳米碳淋巴结示踪技术联合根治术的淋巴结清扫数,降低肿瘤标志物水平和HKDC1蛋白阳性表达率,改善患者凝血功能,降低分期作用明显,可提高手术质量。

Objective To study the perioperative application of Huachansu injection in esophagogastric junction adenocarcinoma with nano-carbon lymph node tracing for radical surgery and its impact on HKDC1 and ANXA13 protein expression.Methods 80 patients who underwent radical surgery for esophagogastric junction adenocarcinoma at Jiangnan Hospital Affiliated to Zhejiang Chinese Medicine University from January 2018 to December 2020 were selected.Based on the different treatment methods,they were divided into nano group and Huachansu group,with 40 cases in each group.The nanogroup received surgical resection+nano-carbon tracing lymph node dissection,while the Huachansu group received perioperative Huachansu injection combined with surgical resection+nano-carbon tracing lymph node dissection.The two groups were compared in terms of lymph node detection,tumor marker levels,coagulation function,postoperative pathological staging,and HKDC1 and ANXA13 protein expression.Results The total number of lymph nodes,target lymph nodes,and peripheral lymph nodes in the Huachansu group were all lower than those in the nano group(P<0.05).The levels of carbohydrate antigen 19-9(CA19-9),carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),and neuron specific enolase(NSE)in the Huachansu group were all lower than those in the nano group(P<0.05).The coagulation function in the Huachansu group was better than that in the nano group(P<0.05).Compared with before treatment,both groups showed an increase in insulin-like growth factor binding protein(IGFBP)-3 and a decrease in circAGFG1 after treatment,with the Huachansu group showing a greater improvement(P<0.05).In terms of postoperative T staging,the Huachansu group had 18 cases of pT0-2 stage and 22 cases of pT3-4 stage,while the nano group had 1 case of pT0-2 stage and 39 cases of pT3-4 stage,with a significant difference between the two groups(χ^(2)=19.948,P<0.001),and no significant difference in postoperative N staging(P>0.05).The positive expression rates of HKDC1 in the Huachansu group and the nano group were 42.5%(19/40)and 70.0%(28/40),respectively,with a significant difference between the two groups(χ^(2)=4.718,P=0.040);there was no significant difference in the positive expression rate of ANXA13(P>0.05).Conclusion Huachansu can effectively increase the number of lymph node dissections in esophagogastric junction adenocarcinoma patients undergoing nano-carbon lymph node tracing technology combined with radical surgery without affecting other surgical indicators,reduce tumor marker levels and the positive expression rate of HKDC1 protein,improve coagulation function,and have a significant downstaging effect,which can improve the quality of surgery.