高发区食管癌的早期基因治疗和预防

目的 将治疗大鼠骨髓增生异常综合征(MDS)和红白血病所用的V-erbB反基因寡核苷酸(ODN,B1和B2)粉针剂应用于高发区食管癌早期和食管原位癌患者的基因治疗.方法 应用两种治疗方案,即第1方案(B1+B2)和第2方案(B1+B2+CpG),分别对41例食管上皮非典型增生(中度增生15例,重度增生26例)及5例食管原位癌患者,在内窥镜下进行局部喷洒药物治疗,隔日1次,连续3次为1个疗程.1～2个月后复查和病理检查.并于治疗后5年进行随访复查.结果 41例食管上皮非典型增生患者应用第1方案治疗,其中33例从中度增生或重度增生逆转为轻度增生或正常,有效率为80.5%.8例无效,其中1例进展为原位癌.第2方案治疗5例原位癌,3例有效(1例逆转为重度增生.1例逆转为轻度增生,1例逆转为轻度食管炎),2例无效.治疗后5年随访,84.2%患者已痊愈.结论 上述两个治疗方案对高发区癌症的二级预防意义重大.

Gene therapy and prevention for esophageal cancer

Objective　Ｔo treat esophageal cancer (EC) at early stage of pathogenesis by using gene therapy technique. In rat myelodysplastic syndrome(MDS), the antigene V-erbB oligodeoxynucleotides(ODN) were used. Methods　Two schemes were employed: First: the antigene V-erbB ODN(B1+B2) were used to treat 41 patients with premalignancy including 15 with moderate and 26 with heavy proliferation of epithelial cells. Second: the antigene V-erbB ODN and an immuno-adjuvant, CpG ODN were used to treat 5 patients with local EC simultaneously. Under endoscope the ODN were locally administrated, one time, per 2 days and consecutively 3 times. 1-2 months and 5 years later they were re-examined, respectively. 2, 5 years after gene therapy, the follow-up was made. Results　The reverse of moderate and heavy proliferation of epithelial cells to light and normal ones were found in 80.5 %(33/41) patients with atypical proliferation. Only 2 patients relapsed. This indicated that the curative effects were stable. In the second follow-up, 84.2 % patients recovered fully. Conclusion　The above two schemes may be valuable in second degree-prevention of cancers.