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目的 探讨肿瘤坏死因子(TNF-α)在胆囊结石及癌变过程中的变化。 方法 用放射免疫法对53例胆囊结石,9例胆囊癌血清及胆汁中TNF水平进行检测。 结果 血清及胆汁中TNF水平(ng/mL)胆囊癌组(1.35±0.28,10.28±3.23)较胆石症组(0.93±0.23,3.38±1.11)及对照组(0.67±0.17,2.12±0.55)均显著升高(P<0.01),胆囊粘膜从典型增生、非典型增生到胆囊癌的发展过程中TNF水平在血清(0.85±0.14,1.09±0.28,1.35±0.28)及胆汁中(3.04±0.93,4.05±1.17,10.28±3.23)逐级增高(各组间P<0.01),胆汁中TNF水平在胆囊癌Ⅰ～Ⅲ期(8.66±0.22)与Ⅳ～Ⅴ期(13.5±2.98)间差异显著(P<0.01),肿瘤直径≥2cm组(12.26±2.34)与≤2cm组(7.80±1.86)间差异显著(P<0.05),胆汁中TNF水平明显高于其对应的血清水平,两者之间呈正直线相关(r=0.68,P<0.001),胆囊癌术后血清TNF水平显著下降。 结论 TNF参与胆囊结石致癌的过程,与胆囊癌的临床生物学特点密切相关。
Objective To investigate the changes of tumor necrosis factor (TNF-α) in gallstone and carcinogenesis. Methods Radioimmunoassay was used to detect the levels of TNF in 53 gallbladder stones, 9 gallbladder carcinomas and bile. Results The levels of TNF in serum and bile (1.35 ± 0.28, 10.28 ± 3.23) in gallbladder cancer group were significantly higher than those in gallstone group (0.93 ± 0.23, 3.38 ± 1.11) and control group (0.67 ± 0.17, 2.12 ± 0.55) (P <0.01). The levels of TNF in gallbladder mucosa from the typical hyperplasia and atypical hyperplasia to gallbladder carcinomas were significantly higher in serum (0.85 ± 0.14, 1.09 ± 0.28 and 1.35 ± 0.28) and in bile (3.04 ± 0.93, 4.05 ± 1.17,10.28 ± 3.23) (P <0.01). The level of TNF in gallbladder was significantly different between gallbladder carcinoma stage Ⅰ ~ Ⅲ (8.66 ± 0.22) and stage Ⅳ ~ Ⅴ (13.5 ± 2.98) (P <0.01). There was a significant difference (P <0.05) between tumor diameter≥2cm group (12.26 ± 2.34) and≤2cm group (7.80 ± 1.86), the level of TNF in bile was significantly higher than the corresponding serum level (R = 0.68, P <0.001). The level of serum TNF in patients with gallbladder cancer decreased significantly after operation. Conclusion The involvement of TNF in carcinogenesis of gallstone is closely related to the clinical biological characteristics of gallbladder carcinoma.