肝癌患者血浆肿瘤坏死因子及其可溶性受体Ⅰ的意义

目的：探讨肝癌患者血浆TNF和sTNFR-I的临床意义。方法：分别用放射免疫法和ELISA法检测36例肝癌患者血浆TNF和sTNFR-I。结果：肝癌患者血浆TNF、sTNFR-I均显著高于肝硬变和正常人。sTNFR-I水平与AFP、TB、g-GT、ALP无产，与血清白蛋白水平呈负相关。Ⅲ、Ⅳ期或门脉癌栓患者sTNFR-I高于Ⅱ期或门脉无癌栓患者，TNF与分期及门脉癌栓无关；有效治疗后sTNFR-I水平明降低。结论：sTNFR-I可能参与了肿瘤细胞的免疫逃避机制。检测sTNFR-I有助于解肝癌患者的免疫状态、病程分期、判断预后、监测治疗，临床价值优于TNF测定。

The significance of plasma TNF and its soluble receptor I for patients with primary hepatocellular carcinoma

Objective: To investigate the clinical significance of measurement of sTNFR-I and TNF in patients with primary hepatocellular carcinoma (PHC). Methods: Plasma TNF and sTNFR-I levels were measured in 36 patients with PHC by radioimmunoassay and ELISA respectively. Results: Both plasma levels of TNF and sTNFR-I in PHC were significantly higher than those in liver cirrhosis and healthy controls, which did not correlate with AFP, total bilirubin, g-GT, ALP, but negatively correlated with serum albumin concentration. sTNFR-I in patients with PHC of stage TNM III-IV or with portal embolus were significantly higher than those of stage II or without portal embolus. TNF correlated with neither stage nor portal embolus. sTNFR-I decreased significantly after effective therapy. Conclusion: sTNFR-I possibly involved in the immunological escape mechanism of tumor cells. Plasma sTNFR-I levels in patients with PHC correlated with disease status closely and the determination could be helpful to recognize patients' immune status and staging of disease , predict prognosis, monitor therapy with a clinical value much better than TNF.