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目的研究胃癌患者血清及组织中可溶性肿瘤坏死因子受体-Ⅰ(sTNFR-Ⅰ)变化的临床意义。方法采用双抗体夹心ELISA法,对66例胃癌患者手术前后、38例胃良性疾病患者(慢性浅表性胃窦炎患者30例,功能性消化不良8例)及40例健康体检者血清sTNFR-Ⅰ水平进行检测;同时检测了胃癌及胃良性疾病者活检组织中sTNFR-Ⅰ的浓度。结果胃癌患者血清sTNFR-Ⅰ为2.36±0.78μg/ml,明显高于胃良性疾病者(0.82±0.28.ng/ml)和健康体检者(0.78±0.27ng/ml),P<0.001。胃癌组织中sTNFR-Ⅰ为2.52±0.86ng/ml,明显高于胃良性疾病胃黏膜组织(0.86±0.33ng/ml),P<0.001。胃癌按Ⅰ-Ⅳ级分期的不同,sTNFR-Ⅰ在血清和组织中逐渐增高,且各期之间进行比较均P<0.01;其中Ⅰ期(12例)、Ⅱ期(14例)、Ⅲ期(25例)术后血清sTNFR-Ⅰ明显下降,与术前相比各自P<0.01;而Ⅳ期患者(15例)手术前后无明显变化且有所增高;手术切除组(53例,根治或姑息切术)术后sTNFR-Ⅰ明显降低(P<0.001),而探查者或胃空肠吻合术者(13例)术后血清sTNFR-Ⅰ反而增高。结论动态观察血清及组织中sTNFR-Ⅰ的变化可作为胃癌的诊断、手术方法选择、疗效评价及预后监测有意义的参考指标。
Objective To study the clinical significance of the changes of soluble tumor necrosis factor receptor-Ⅰ (sTNFR-Ⅰ) in serum and tissues of gastric cancer patients. Methods Thirty-eight patients with gastric benign disease (30 with chronic superficial antral gastritis, 8 with functional dyspepsia) and 40 healthy controls were enrolled in this study. Serum sTNFR- Ⅰ levels were detected; simultaneous detection of gastric cancer and gastric benign disease biopsy tissue concentration of sTNFR-Ⅰ. Results The serum sTNFR-Ⅰ in gastric cancer patients was 2.36 ± 0.78μg / ml, significantly higher than that in benign gastric diseases (0.82 ± 0.28ng / ml) and healthy subjects (0.78 ± 0.27ng / ml), P <0.001. The gastric cancer sTNFR-Ⅰ was 2.52 ± 0.86ng / ml, which was significantly higher than gastric benign gastric mucosa (0.86 ± 0.33ng / ml), P <0.001. The levels of sTNFR-Ⅰ in serum and tissues increased gradually in stage Ⅰ-Ⅳ staging, and all the stages were compared between two groups (P <0.01). Among them, stage Ⅰ (12 cases), stage Ⅱ (14 cases), stage Ⅲ (N = 25). The serum levels of sTNFR-Ⅰ in patients after operation were significantly lower than those before operation (P <0.01), while those in patients with stage Ⅳ (15 patients) did not change significantly STNFR-Ⅰ was significantly lower (P <0.001) after palliative resection, while the serum sTNFR-Ⅰ was increased in those who underwent gastrojejunostomy (13 cases). Conclusions Dynamic observation of the changes of sTNFR-Ⅰ in serum and tissue can be used as a useful reference for the diagnosis of gastric cancer, selection of operative methods, evaluation of curative effect and prognosis monitoring.