术前经动脉化疗栓塞对肝细胞癌细胞凋亡的影响

Effect of Preoperative Transcatheter Arterial Chemoembolization on the Apoptosis of Hepatocellular Carcinoma Cells

目的 评价术前经导管动脉化疗栓塞 (TACE)对肝细胞癌 (HCC)细胞凋亡的影响。资料与方法 经手术病理证实的HCC 136例 ,其中行 1～ 5次TACE后Ⅱ期手术切除 79例 (TACE组 ) ,按治疗方式不同分 4组 ,A组 :仅灌注化疗药物 11例 ,治疗 1～ 4次 ;B组 :化疗药 +碘化油栓塞 33例 ,治疗 1～ 5次 ;C组 :化疗药 +碘化油 +明胶海绵颗粒栓塞 2 3例 ,治疗 1～ 3次 ;D组 :化疗药 +碘化油、无水乙醇、明胶海绵颗粒栓塞 12例 ,治疗 1～ 3次。单纯手术5 7例 (非TACE组 ) ,用TUNEL(terminaldeoxynucleotidyltransferase (TdT) mediateddUTP digoxigeninnick endlabeling)法检测凋亡细胞 ,用免疫组织化学检测各标本Bcl 2和Bax蛋白表达。结果 TACE组的A、B、C、D各组HCC细胞凋亡指数及Bax蛋白表达均显著高于非TACE组 ;而Bcl 2蛋白表达及Bcl 2和Bax蛋白表达比值TACE组的A、B、C、D各组均显著低于非TACE组。结论 术前TACE通过上调Bax蛋白表达 ,下调Bcl 2蛋白表达及Bcl

Objective To evaluate the effect of preoperative transcatheter arterial chemoembolization (TACE) on the apoptosis of hepatocellular carcinoma (HCC) cells.Materials and Methods A total of 136 patients with HCC underwent liver resection. Before liver resection 1～5 courses of TACE were performed in 79 patients (TACE group), of which 1～4 courses of chemotherapy alone were performed in 11 (group A), 1～5 courses of chemotherapy together with iodized oil embolization in 33 (group B), 1～3 courses of chemotherapy coupled with iodized oil and Gelfoam particles embolization in 23 (group C) and 1～3 courses of chemotherapy combined with iodized oil, ethanol and Gelfoam particles embolization in 12 (group D). The remaining 57 patients received surgery only (non TACE group). The extent of apoptosis was estimated by terminal deoxyucleotidyl transferase mediated dUTP digoxigenin nick end labeling (TUNEL) technique. The expressions of Bcl 2 and Bax protein were tested by immunohistochemical method.Results The apoptotic index (AI) and the positive rate of Bax protein of HCC cells were significantly higher, while the positive rate of Bcl 2 protein and ratio of Bcl 2 to Bax protein of HCC cells were significantly lower, in groups A, B, C and D than those in non TACE group (P<0.05).Conclusion Preoperative TACE regimens may enhance the apoptosis of HCC cells through the mechanism of up regulating the expression of Bax protein and down regulating both the expression of Bcl 2 protein and the ratio of Bcl 2 to Bax protein expression.