胆囊结石及癌变过程中肿瘤坏死因子可溶性受体的变化

Soluble tumor necrosis factor receptore-Ⅰ in gallbladder cancer and gallstone

目的 探讨可容性肿瘤坏死因子受体 (sTNFR)在胆囊结石及癌变过程中的变化。方法 用双抗体夹心酶联免疫法对 5 3例胆囊结石 ,9例胆囊癌及 11例正常对照者血清及胆法中的sTNFR水平进行检测。结果 血清及胆汁中sTNFR水平胆囊癌组为 (2 .63± 0 .5 6) μg/L、(10 .0 2± 3 .2 3 ) μg/L较胆石症组 (1.2 5± 0 .3 6) μg/L、(2 .81± 0 .93 ) μg/L及对照组 (0 .95± 0 .19)μg/L、(1.83± 0 .5 4) μg/L均显著升高 (P <0 .0 1)。胆囊黏膜从典型增生、非典型增生到胆囊癌的发展过程中sTNFR在血清 (1.11± 0 .2 8、1.5 3± 0 .3 2、2 .63± 0 .5 6)及胆汁中 (2 .5 0± 0 .81、3 .42±0 .87、10 .0 2± 3 .2 3 )逐级增高 (各组间P <0 .0 5 )。胆汁中sTNFR水平在胆囊癌Ⅰ～Ⅲ期 (8.3 6±2 .60 )与Ⅳ～Ⅴ期 (13 .3 3± 4.46)间差异有显著性 (P <0 .0 0 1) ,肿瘤直径≥ 2cm组 (12 .10± 2 .3 2 )与 <2cm组 (7.42± 2 .10 )间差异有显著性 (P <0 .0 5 )。胆汁中TNFR水平明显高于其对应的血清水平 ,两者之间呈正直线相关 (r =0 .875 ,P <0 .0 0 1)。胆囊癌术后血清sTNFR水平显著下降。结论 sTNFR参与胆囊结石致癌的过程 ,与胆囊癌的临床生物学特点密切相关。

Objective To reveal the role of soluble tumor necrosis factor receptore-Ⅰ (sTNFR) in the developing course of gallbladder carcinoma with gallstone.Methods The leve of sTNFR was detected by RIA in 9 patients with gallbladder carcinoma,53 patients with gallstone and 11 normal subjects.Results The levels (μg/L) of sTNFR in plasma and bile of the cancer group (2.63±0.56, 10.02± 3.23 respectively) were significantly higher than those of the gallstone (1.25±0.36,2.81± 0.93 respectively) and normal group (0.95±0.19,1.83±0.54 respectively) (P<0.01).The levels of sTNFR in the plasma (1.11±0.28,1.53±0.32,2.63±0.56 respectively) and bile (2.50±0.81, 3.42± 0.87,10.02±3.23 respectively) were increased gradulay during the course of the development of gallbladder mucosa from hyperplasia,dysplasia to carcinoma (P<0.001).The levels of sTNFR in bile of the Ⅳ-Ⅴ stages of cancer group (13.33±4.46) was significantly higher than those of the Ⅰ-Ⅲ stages of cancer group (8.36±2.60) (P<0.001).The level of sTNFR in bile of the sumor size above 2 cm group (12.10±2.32) was higher remarkedly than that of less 2 cm group (7.42±2.10) (P<0.05).The level of sTNFR in bile were much higher than in plasma and there was a linear correlation between them (r=0.875,P<0.001).The level of sTNFR in plasma was decreased greatly after operation.Conclusion sTNFR participated in the pathogenesis of gallbladder carcinoma induced by gallstone.The levels of sTNFR were correlated well with tumor clinial characters.