【摘要】： 目的 探討熒光定量RT-PCR檢測外周血CK14 mRNA、EGFR mRNA的表達(dá)在鼻咽癌患者外周血微轉(zhuǎn)移診斷中的價值。 方法 篩選符合入組標(biāo)準(zhǔn)的鼻咽癌患者87例,經(jīng)詳細(xì)詢問病史、認(rèn)真查體、完善相關(guān)的影像學(xué)檢查,治療前1周內(nèi),由兩名耳鼻咽喉頭頸外科主治醫(yī)師以上確定腫瘤TNM分期和臨床分期,參照中醫(yī)辨證分型標(biāo)準(zhǔn)確定中醫(yī)證型,組織分化程度以病理科病理報告結(jié)果為準(zhǔn)。采用熒光定量RT-PCR方法檢測87例入組患者外周血CK14 mRNA、EGFR mRNA的表達(dá)情況,并分析其與腫瘤TNM分期、臨床分期、組織分化程度及中醫(yī)證型之間的關(guān)系。 結(jié)果 1、87例鼻咽癌患者外周血中CK14 mRNA、EGFR mRNA陽性表達(dá)率分別為64.4%(56/87)、58.6%(51/87),兩者聯(lián)合檢測的陽性表達(dá)率為71.3%(62/87),5例遠(yuǎn)處轉(zhuǎn)移鼻咽癌患者的外周血和5例腫瘤組織中均有表達(dá)(CK14 mRNA、EGFR mRNA陽性表達(dá)率為100%),而10例正常人外周血中未見表達(dá)； 2、鼻咽癌患者外周血CK14 mRNA、EGFR mRNA的陽性表達(dá)率與年齡、性別經(jīng)統(tǒng)計學(xué)分析無關(guān)(P0.05),而與腫瘤的組織分化程度、臨床分期有關(guān)(P0.05)； 3、鼻咽癌患者外周血中CK14 mRNA、EGFR mRNA的表達(dá)水平與T分期、N分期、臨床分期有關(guān)(P0.05),分期越晚,外周血中CK14 mRNA、EGFR mRNA的表達(dá)水平越高； 4、鼻咽癌患者外周血中CK14 mRNA、EGFR mRNA的表達(dá)水平與組織分化程度有關(guān)(P0.05),低分化鱗癌外周血中CK14 mRNA、EGFR mRNA的表達(dá)水平高于高中分化鱗癌； 5、鼻咽癌患者的中醫(yī)證型在不同臨床分期上的分布具有統(tǒng)計學(xué)意義(P0.05),中醫(yī)證型中氣血凝結(jié)型主要集中在Ⅰ期,占54.5%(6/11),痰濁結(jié)聚型主要集中在Ⅱ期,占64%(16/25),火毒困結(jié)型主要集中在Ⅲ期,占61.5%(24/39),正虛毒滯型主要集中在Ⅳ期,占66.7%(8/12),且外周血CK14 mRNA、EGFR mRNA的表達(dá)水平與中醫(yī)證型有關(guān)(P0.05),正虛毒滯型火毒困結(jié)型痰濁結(jié)聚型氣血凝結(jié)型。 結(jié)論 1、熒光定量RT-PCR方法檢測鼻咽癌患者外周血CK14 mRNA、EGFR mRNA的表達(dá),能夠較準(zhǔn)確反映外周血微轉(zhuǎn)移的情況,在診斷鼻咽癌患者外周血微轉(zhuǎn)移方面有一定的可行性； 2、鼻咽癌患者外周血微轉(zhuǎn)移與腫瘤的惡性程度和病情進(jìn)展有關(guān); 3、鼻咽癌患者中醫(yī)辨證分型與臨床分期關(guān)系密切,隨著臨床分期的進(jìn)展,其中醫(yī)證型呈現(xiàn)出“氣血凝結(jié)型→痰濁結(jié)聚型→火毒困結(jié)型→正虛毒滯型”總的演變趨勢,且隨著中醫(yī)證型的演變,外周血中CK14 mRNA、EGFR mRNA的表達(dá)水平逐漸升高。
[Abstract]:Objective to evaluate the value of fluorescence quantitative RT-PCR (FQ-RT-PCR) in the diagnosis of peripheral blood micrometastasis in patients with nasopharyngeal carcinoma (NPC). Methods 87 patients with nasopharyngeal carcinoma who met the criteria of admission were selected. After detailed medical history, careful physical examination and perfect related imaging examination, within one week before treatment, the TNM stage and clinical stage of the tumor were determined by two attending doctors of otorhinolaryngology head and neck surgery, and the TCM syndrome type was determined according to the TCM syndrome differentiation standard, and the degree of tissue differentiation was based on the pathological report results of pathology department. The expression of CK14 mRNA,EGFR mRNA in peripheral blood of 87 patients was detected by fluorescence quantitative RT-PCR, and the relationship between CK14 mRNA,EGFR mRNA expression and tumor TNM stage, clinical stage, degree of tissue differentiation and TCM syndrome type was analyzed. Results 1the positive expression rates of CK14 mRNA,EGFR mRNA in peripheral blood of 87 patients with nasopharyngeal carcinoma (NPC) were 64.4% (56%) and 58.6% (51%), respectively. The positive expression rates of CK14 mRNA,EGFR mRNA were 71.3% (62%) in combined detection, 100% (100%) in peripheral blood of 5 patients with distant metastasis of nasopharyngeal carcinoma (NPC), but no expression was found in 10 normal controls. 2. The positive expression rate of CK14 mRNA,EGFR mRNA in peripheral blood of patients with nasopharyngeal carcinoma (NPC) was not related to age and sex (P 0.05), but related to the degree of tumor differentiation and clinical stage (P 0.05). 3. The expression level of CK14 mRNA,EGFR mRNA in peripheral blood of patients with nasopharyngeal carcinoma was related to T stage, N stage and clinical stage (P 0.05). The later the stage, the higher the expression level of CK14 mRNA,EGFR mRNA in peripheral blood. 4. The expression level of CK14 mRNA,EGFR mRNA in peripheral blood of patients with nasopharyngeal carcinoma was related to the degree of tissue differentiation (P 0.05). The expression level of CK14 mRNA,EGFR mRNA in peripheral blood of poorly differentiated squamous cell carcinoma was higher than that of highly differentiated squamous cell carcinoma. 5. the distribution of TCM syndrome types in different clinical stages of nasopharyngeal carcinoma patients was statistically significant (P 0.05). The type of qi and blood coagulation was mainly in stage I, accounting for 54.5% (6 鈮，

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