【摘要】：目的:研究多效蛋白(pleiotrophin,PTN)在胃癌組織及胃癌患者外周血中的表達,進一步探討PTN在胃癌發(fā)病過程的作用以及其在胃癌診斷、治療策略制定和預(yù)后判斷作用。方法:1.收集在我院于2015年03月 2016年12月行胃癌根治手術(shù)患者70例(設(shè)為實驗組),在我院行健康體檢者30例(設(shè)為對照組)。確立納入標(biāo)準(zhǔn)以及排除標(biāo)準(zhǔn):納入標(biāo)準(zhǔn):(1)術(shù)前通過胃鏡和病理檢查明確診斷為胃癌患者;(2)擬行胃癌根治手術(shù)者;(3)心、肺等重要的臟器功能良好,能夠承受胃癌手術(shù)打擊;(4)知曉實驗方法和實驗?zāi)康?自愿參加并配合。排除標(biāo)準(zhǔn):(1)胃癌術(shù)后出現(xiàn)復(fù)發(fā)、殘胃癌、合并其他腫瘤者;(2)既往有胃腸道手術(shù)史或胃潰瘍、腸炎病史者;(3)伴有心肺等重要臟器功能不全者;(4)有造血系統(tǒng)疾病者;(5)近期使用免疫抑制劑、激素類藥物或血液制品者;(6)合并有嚴(yán)重營養(yǎng)不良者;(7)術(shù)前行放化療、免疫治療及或其他相關(guān)治療者。2.術(shù)中取患者胃癌組織及癌旁正常組織(距腫瘤組織5cm),通過免疫組織化學(xué)方法測定其PTN表達,并分析PTN表達與胃癌臨床病理特征之間的關(guān)系。3.入院后抽取外周血,通過ELISA法測定血液中PTN的表達水平,通過比較胃癌患者與健康體檢者外周血中PTN表達差異,分析其與腫瘤TNM分期、腫瘤分型等臨床病理特征之間的關(guān)系。結(jié)果:1.胃癌組織中PTN陽性表達率(81.4%)明顯高于遠癌組織(11.4%),組間差異具有統(tǒng)計學(xué)意義(P0.05)。胃癌組織中PTN的表達:胃癌組織直徑≥4cm者的PTN表達高于胃癌組織直徑4cm(P0.05);TNM分期中Ⅲ-Ⅳ期患者高于Ⅰ-Ⅱ期患者(P0.05);中分化+高分化胃癌患者低于未分化+低分化胃癌患者(P0.05);Borrmann分型的0-Ⅱ型胃癌患者低于Ⅲ-Ⅳ型胃癌患者(P0.05);有淋巴結(jié)轉(zhuǎn)移組高于無淋巴結(jié)轉(zhuǎn)移組(P0.05)。PTN在胃癌組織中的表達與年齡和性別無關(guān)(P0.05)。2.胃癌患者外周血中PTN濃度為(54.739±20.300)ng/ml,明顯高于體檢組(5.041±2.255)ng/ml,差異有統(tǒng)計學(xué)意義(P0.05)。PTN在胃癌患者外周血中的表達:胃癌組織直徑≥4cm者的PTN表達高于胃癌組織直徑4cm(P0.05);TNM分期中Ⅲ-Ⅳ期患者高于Ⅰ-Ⅱ期患者(P0.05);有淋巴結(jié)轉(zhuǎn)移組高于無淋巴結(jié)轉(zhuǎn)移組(P0.05)。胃癌患者外周血中PTN濃度與性別、年齡和分化程度無關(guān)(P0.05)。結(jié)論:1.胃癌組織中PTN表達水平較遠癌組織明顯升高,判斷手術(shù)切緣陰陽性及微轉(zhuǎn)移。2.胃癌患者外周血PTN表達水平高于健康體檢者的表達水平,與胃癌患者腫瘤大小、TNM分期、淋巴結(jié)轉(zhuǎn)移等臨床病理學(xué)特征有關(guān),有望成為胃癌診斷的檢驗學(xué)指標(biāo)。3.PTN在胃癌組織中的表達與腫瘤分期、分型及分化程度相關(guān),提示PTN可為胃癌診斷、治療策略制定以及預(yù)后提供參考。4.PTN能為胃癌的篩查及診斷提供依據(jù)。
[Abstract]:Objective: to investigate the expression of multifunctional protein (pleiotrophin,PTN) in gastric cancer tissues and peripheral blood of patients with gastric cancer, and to explore the role of PTN in the pathogenesis of gastric cancer and in the diagnosis, treatment strategy and prognosis of gastric cancer. Methods: 1. A total of 70 patients (experimental group) and 30 healthy persons (control group) underwent radical gastrectomy in our hospital from March 2015 to December 2016 were collected. Establishment of inclusion criteria and exclusion criteria: (1) preoperative diagnosis of gastric cancer by gastroscopy and pathological examination; (2) preparation of radical surgery for gastric cancer; (3) the important organs such as heart and lung have good function and can withstand the attack of gastric cancer surgery. (4) knowing the experimental method and purpose, volunteer to participate and cooperate. Exclusion criteria: (1) recurrence of gastric cancer after operation, residual gastric cancer, complicated with other tumors; (2) previous gastrointestinal surgery or gastric ulcer, enteritis history; (3) patients with heart and lung dysfunction; (4) hematopoietic diseases; (5) recent use of immunosuppressants, hormone drugs or blood products; (6) severe malnutrition; (7) preoperative radiotherapy, chemotherapy, immunotherapy and other related treatments. 2. The expression of PTN in gastric cancer tissues and adjacent normal tissues (5cm) was determined by immunohistochemical method. The relationship between PTN expression and clinicopathological features of gastric cancer was analyzed. 3. The expression of PTN in peripheral blood was measured by ELISA method after admission. The expression of PTN in peripheral blood of patients with gastric cancer was compared with that of healthy controls, and the relationship between PTN expression and clinicopathological features such as tumor TNM staging and tumor classification was analyzed. Results: 1. The positive expression rate of PTN in gastric cancer (81.4%) was significantly higher than that in distant carcinoma (11.4%), and the difference was statistically significant (P0.05). The expression of PTN in gastric cancer: the expression of PTN in gastric cancer with diameter 鈮，

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