醫(yī)學(xué)論文范文:EGFR和SBEM聯(lián)合檢測(cè)在乳腺癌外周血微轉(zhuǎn)移中的意義
【摘要】 目的:探討乳腺癌患者外周血表皮生長(zhǎng)因子受體(EGFR)及乳腺上皮粘蛋白(SBEM)的表達(dá)及臨床意義。方法:采用酶聯(lián)免疫吸附試驗(yàn)(ELISA法)定量檢測(cè)58例乳腺癌患者及30例乳腺纖維腺瘤患者術(shù)前血清中EGFR和SBEM的含量。結(jié)果:乳腺癌組術(shù)前血清EGFR和SBEM含量均高于纖維腺瘤對(duì)照組 (P<0.01)。有淋巴結(jié)轉(zhuǎn)移的乳腺癌患者血清中EGFR和SBEM含量明顯高于無淋巴結(jié)轉(zhuǎn)移者,Ⅲ+Ⅳ期患者血清中EGFR和SBEM含量亦顯著高于Ⅰ+Ⅱ期,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。乳腺癌患者術(shù)前血清中EGFR和SBEM含量無相關(guān)性(r=-0.45,P=0.74)。結(jié)論:EGFR及SBEM特異性表達(dá)于乳腺癌外周血,有可能作為檢測(cè)乳腺癌外周血微轉(zhuǎn)移的標(biāo)志物,并有可能在乳腺癌微轉(zhuǎn)移診斷和預(yù)后判斷中具有重要意義。
【關(guān)鍵詞】 表皮生長(zhǎng)因子受體 乳腺上皮粘蛋白 乳腺癌
Detection of EGFR and SBEM in peripheral blood from patients with breast cancer and its significance
ZHANG Di, HUANG Yanchun醫(yī).學(xué)全.在.線網(wǎng)站m.zxtf.net.cn
(Department of Clinical Laboratory, Affiliated Tumor Hospital, Xinjiang Medical University,Urumqi 830011, China)
Abstract: Objective: To explore the expressions of epidermal growth factor receptor (EGFR) and small breast epithelial mucin (SBEM) in peripheral blood from patients with breast cancer and their clinical significance. Methods: The expressions of EGFR and SBEM in serum were detected from 58 patients with breast cancer, 30 breast fibroadenoma by enzymelinked immunosorbent assay (ELISA). Results: Compared with breast fibroadenoma group, the levels of serum EGFR and SBEM in breast cancer were much higher (P<0.01). The levels of serum EGFR and SBEM of patients with lymph node metastasis were significantly higher than those in the negative, and the levels of patients in stages Ⅲ+Ⅳ were also significantly higher than those in the stagesⅠ+Ⅱ (P<0.05). The serum EGFR level was not correlated with the serum SBEM level (r=-0.45,P=0.74). Conclusion: EGFR and SBEM are specifically expressed in peripheral blood of breast cancer patients, and each of them may be marker of micrometastasis of breast cancer.
Key words: epidermal growth factor receptor(EGFR); small breast epithelial mucin (SBEM); breast cancer
近年來,中國(guó)乳腺癌的發(fā)病率在女性惡性腫瘤中已躍居首位[1]。大約有30%的乳腺癌患者最終發(fā)生遠(yuǎn)處轉(zhuǎn)移[2]。乳腺癌轉(zhuǎn)移無固定模式,早期乳腺癌即可發(fā)生隱匿性轉(zhuǎn)移。血液循環(huán)中的腫瘤細(xì)胞是導(dǎo)致乳腺癌血行轉(zhuǎn)移和復(fù)發(fā)的重要原因之一,因此,早期外周血微轉(zhuǎn)移的檢測(cè),對(duì)指導(dǎo)乳腺癌臨床治療和判斷預(yù)后具有重要意義。我們采用酶聯(lián)免疫吸附試驗(yàn)(ELISA法)檢測(cè)乳腺癌患者外周血中EGFR和SBEM的表達(dá),探討其在乳腺癌微轉(zhuǎn)移中的臨床意義。
1材料與方法
1.1研究對(duì)象選擇2008年3月~2008年8月在我院行手術(shù)治療,無肝炎以及免疫系統(tǒng)疾病等合并癥,經(jīng)病理確診為乳腺癌和乳腺纖維腺瘤的患者88例。其中乳腺癌組58例,患者均為女性,年齡30~77歲,平均年齡50.1歲,中位年齡48.5歲。浸潤(rùn)性導(dǎo)管癌48例,髓樣癌2例,粘液癌2例,浸潤(rùn)性小葉癌3例,混合型癌(浸潤(rùn)性導(dǎo)管癌和浸潤(rùn)性小葉癌)3例。按照UICC1988年制訂的乳腺癌TNM分期標(biāo)準(zhǔn):Ⅰ期15例,Ⅱ期21例,Ⅲ期19例,Ⅳ期3例。良性對(duì)照組均為乳腺纖維腺瘤,患者均為女性,年齡27~49歲,平均年齡38.9歲,中位年齡39歲。所有患者術(shù)前未接受過放化療或生物治療等干預(yù)措施。
1.2方法
1.2.1標(biāo)本采集兩組均抽取空腹靜脈血2 ml于真空采血管(含分離膠,美國(guó)BD)內(nèi),靜置1 h,以3 000 r/min離心10 min分離血清,-20 ℃冰箱保存待測(cè)醫(yī).學(xué)全.在.線網(wǎng)站m.zxtf.net.cn。
1.2.2實(shí)驗(yàn)方法兩組均采用ELISA法測(cè)定,試劑盒均購(gòu)自美國(guó)R&D Systems公司,檢測(cè)步驟嚴(yán)格按試劑盒說明書進(jìn)行。ELISA數(shù)據(jù)分析由TECAN全自動(dòng)酶標(biāo)儀RMP150型讀取。EGFR單位為fmol/L, SBEM單位為ng/ml。
1.3統(tǒng)計(jì)學(xué)處理用SPSS13.0軟件包進(jìn)行統(tǒng)計(jì)學(xué)處理。采用非參數(shù)統(tǒng)計(jì)方法,數(shù)據(jù)以中位數(shù)(Median,M)及四分位數(shù)間距(Quartiles,Q)表示。兩組數(shù)據(jù)的比較應(yīng)用完全隨機(jī)設(shè)計(jì)兩樣本比較的秩和檢驗(yàn),相關(guān)分析應(yīng)用Spearman等級(jí)相關(guān)。檢驗(yàn)水準(zhǔn)α=0.05。
2結(jié)果
2.1兩組術(shù)前血清EGFR和SBEM含量的比較乳腺癌組術(shù)前血清EGFR含量91.7(22.3,264.6) fmol/L高于纖維腺瘤對(duì)照組20.9(26.9,55.6) fmol/L,差異有統(tǒng)計(jì)學(xué)意義(Z=-4.213,P<0.01);乳腺癌組術(shù)前血清SBEM含量4.8(1.8,9.3) ng/ml高于纖維腺瘤對(duì)照組1.2(0.98,2.1) ng/ml,差異有統(tǒng)計(jì)學(xué)意義(Z=-3.411,P<0.01)。
2.2乳腺癌患者術(shù)前血清中EGFR和SBEM含量與乳腺癌病理特征的關(guān)系有淋巴結(jié)轉(zhuǎn)移的乳腺癌患者血清中EGFR和SBEM含量明顯高于無淋巴結(jié)轉(zhuǎn)移者,Ⅲ+Ⅳ期患者血清中EGFR和SBEM含量亦顯著高于Ⅰ+Ⅱ期,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05),見表1。
2.3乳腺癌患者術(shù)前血清中EGFR和SBEM含量的相關(guān)性通過Spearman相關(guān)性分析,乳腺癌患者術(shù)前血清中EGFR和SBEM含量無相關(guān)性(r=-0.45,P=0.74)。
表1乳腺癌患者術(shù)前血清中EGFR和SBEM含量與乳腺癌病理特征的關(guān)系(略)