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目的研究西咪替丁预防大肠癌肝转移临床疗效以及与唾液酸化LewisX(SLeX)蛋白表达的关系。方法应用微波-链霉菌素-生物素(微波-LSAB)法检测80例大肠癌SLeX蛋白表达水平。患者分3组,将SLeX阳性表达的73例随机分为2组:①组43例,每天口服氟尿嘧啶200mg和西咪替丁800mg;②组30例,仅每天口服氟尿嘧啶200mg;③组为SleX阴性表达者7例,治疗方法同①组。手术后第3周开始治疗,时间均为1年。对DukesC期患者,3组均在施行LFP方案化疗基础上进行上述治疗。平均随访时间为(10.4±2.6)年。结果以B超、CT发现肝转移灶为比较标准,在10年随访中3组共发现肝转移27例,总体转移率为33.8%,其中①组为20.9%(9/43),②组为53.3%(16/30),③组为(2/7),①组与②组比较,差异有统计学意义(P<0.05),①组与③组,②组与③组比较,差异无统计学意义。共实施肝切除治疗转移灶21例,术后①组+②组肝转移灶SLeX免疫组化染色阳性17例,阳性率89.5%(17/19);③组2例均阴性。对肝转移灶施行切除和继续分组治疗之后,①组、②组和③组1年生存率分别为5/7、5/12和1/2,3组间差异无统计学意义。结论西咪替丁对SLeX蛋白高水平表达的大肠癌有一定的抗肝转移辅助治疗作用,有利于延长患者生存期。
Objective To study the clinical efficacy of cimetidine in preventing liver metastasis of colorectal cancer and its relationship with sialyl Lewis X (SLeX) protein expression. Methods The expression of SLeX protein in 80 cases of colorectal cancer was detected by microwave-streptavidin-biotin (microwave-LSAB). The patients were divided into 3 groups. 73 patients with positive expression of SLeX were randomly divided into 2 groups: ① group of 43 patients, taking oral fluorouracil 200mg and cimetidine 800mg daily; ②group of 30 patients receiving oral fluorouracil 200mg daily only; ③The group was SleX negative Seven cases of expression, treatment with ① group. The first 3 weeks after surgery began treatment, both for 1 year. For DukesC patients, all three groups were treated on the basis of LFP regimen. The average follow-up time was (10.4 ± 2.6) years. Results The liver metastases were found by B-mode ultrasonography and CT. 27 cases of liver metastases were found in 3 groups at 10-year follow-up. The overall rate of metastasis was 33.8% (20.9%, 9/43) 53.3% (16/30) in group A and (2/7) in group ③ The difference between group ① and group ② was statistically significant (P0.05); ② The difference between group ① and ③, ② and ③ was not significant Statistical significance. A total of 21 liver metastases were treated by hepatectomy. Seventeen patients with liver metastases in group ① and group Ⅱ were positive for SLeX immunohistochemical staining, the positive rate was 89.5% (17/19). The other two cases were negative. After resection of liver metastases and continuous grouping treatment, the 1-year survival rates of ①, ② and ③ groups were 5/7, 5/12 and 1/2, respectively. There was no significant difference between the two groups. Conclusion Cimetidine has certain anti-liver metastasis adjuvant effect on colorectal cancer with high expression of SLeX protein, which is beneficial to prolong the survival of patients.