可溶性肿瘤坏死因子受体对消化道肿瘤诊断及其预后的研究

目的 :探讨可溶性肿瘤坏死因子受体在消化道恶性肿瘤患者中的临床意义。方法 :应用双抗体夹心ELISA法对 37例食管癌、41例胃癌、30例大肠癌患者血清可溶性肿瘤坏死因子受体 (sTNFR -Ⅰ ,sTNFR -Ⅱ )水平进行了检测。结果 :三组肿瘤患者血清sTNFR -Ⅰ、sTNFR -Ⅱ水平显著高于对照组 (P <0 .0 1)。食管癌、胃癌、大肠癌三者相比无明显差异 (P >0 .0 5 )。食管癌、胃癌、大肠癌血清sTNFR -Ⅰ增高的百分率分别为 75 .7% (2 8/ 37)、78.0 %(32 / 41)、73.3 % (2 2 / 30 ) ,sTNFR -Ⅱ增高的百分率分别为 6 7.6 % (12 / 37)、75 .6 % (31/ 41)、6 3.3 % (19/ 30 ) ,且随肿瘤临床病理分期增加而增高 ,有转移者显著高于无转移者 ,手术切除肿瘤后sTNFR -Ⅰ、sTNFR -Ⅱ水平明显升高 ,手术后 6mon ,5例病人的血清水平显著低于手术前 ,肿瘤复发时水平再次上升。结论 :血清sTNFR -Ⅰ、sTNFR -Ⅱ水平检测取材容易 ,且可多次重复 ,联合、动态检测手术前后及随访病人有助于对消化道肿瘤病人的免疫功能、治疗效果、预后的临床评价和指导治疗。

A study on the value of diagnosis and prognosis of serum soluble tumor necrosis factor receptors in patients with malignant carcinoma in digestive system

Objective To probe into the clinical significance of serum soluble tumor necrosis factor receptors in patients with malignant carcinoma of digestive system. Methods With sandwich ELISA monoclonal and polyclonal antibodies technique serum levels of sTNFRs (sTNFR-Ⅰ?sTNFR-Ⅱ) were measured in 37 patients with esophageal carcinoma (EC),41 patients with gastric carcinoma (GC), 30 patients with cololrecetal carcinoma (CC).Results The levels of sTNFR-Ⅰ?sTNFR-Ⅱ were significantly higher in patients with EC, GC and CC than those of controls ( P <0 01), but the levels of sTNFR-Ⅰ?sTNFR-Ⅱ were not signficantly different in patients with EC?GC and CC ( P >0 05). The increased percentage of serum levels of sTNFR-Ⅰ in the patients with EC?GC and CC were 75.5%(28/37), 78.0%(32/41), 73.3%(22/30); the in creased percentage of serum levels of sTNFR-Ⅱ were 67.6%(12/37), 75.6%(31/41), 63.3%(19/30). The more advanced the clinicopathologic stage of malignant tumor, the higher serum levels of sTNFR-Ⅰ and sTNFR-Ⅱ. Metastasis patients with EC, GC and CC showed signinficantly higher mean levels of sTNFR-Ⅰ?sTNFR-Ⅱ than those without metastasis. Levels of sTNFR-Ⅰ and sTNFR-Ⅱ were significantly higher in patients with malignant tumor after surgical removal of tumor. 6 monthes after surgical treatment, the levels were much lower than those of preoperation in 5 cases ( P <0.01). A rise again in serum levels was found to correlate with tumour recurrence. Conclusion Measurements of serum sTNFR-Ⅰ and sTNFR-Ⅱ levels provide a simply, easy, repeated and practical test. Associated dymamic state detecion of them in the patients of preoperation and postoperation and follow_up visiting is helpful to evaluate the efficiency of treament,tumor recurrence, prognosics and their furthor treatment.