摘要
目的探讨肺癌患者治疗前后外周血癌胚抗原（CEA）、细胞角蛋向19（CKl9）mRNA的表达水平．及其与肿瘤分期、近期疗效、监测预后的关系。方法应用Taq Man定量逆转录-聚合酶链反应（RT-PCR）检测78例肺癌患者（鳞癌28例、腺癌40例、小细胞肺癌9例、大细胞肺癌1例）治疗前后、30例肺部良性疾病患者及30例健康对照者外周血癌胚抗原（CEA）、细胞角蛋白19（CK19）mRNA的水平；同时采用酶联免疫吸附测定法检测肺癌患者治疗前血清CEA和细胞角蛋白19片段（CYFRA21—1）水平。患者随访2年。结果肺癌患者外周血CEA、CK19mRNA阳性率分别为69．2％（54／78）、62．8％（49／78）．显著高于肺部良性疾病患者及健康对照者，3者差异有统计学意义（χ^2值分别为37．65、41．54；27．41、30．84，p〈0．01）。鳞癌组CK19mRNA阳性率最高，腺癌组CEAmRNA阳性率晟高。不同分期患者问CEA、CK19mRNA阳性率差异无统计学意义（χ^2值分别为3．63、3．81）。肺癌患者外周血CEA、CK19mRNA的阳性率显著高于血清CEA、CYFRA21—1水平；手术后CEA、CK19mRNA阳性率显著下降；化疗后阳性率下降不明显。化疗前CEAmRNA阳性患者的中位生存期明湿低于阴性患者（分别为8．5月、11．7月）、化疗前CK19mRNA阳性患者的中位生存期明显低于阴性患者（分别为8,9月、12．3月）：术前CEAmR—NA阳性患者肿瘤复发或转移率（29．4％）高于术前阴性患者（7．7％），术前CK19mRNA阳性患者肿瘤复发或转移率（18．8％）高于术前阴性患者（7．1％）。结论CEA、CK19mRNA对于检测肺癌患者肿瘤细胞微转移有一定的临床意义．有助于评估手术疗效及预测预后；CEA、CK19mRNA表达水平与肿瘤分期无关；CEA、CK19基因的检测敏感性优于蛋白水平的检测．可有助于肺癌的辅助诊断。
Objective To investigate the expression of carcinoembryonic antigen （CEA） and cytokeratin 19 （CK19） mRNAs in peripheral blood of patients with lung cancer and their relationship between staging, treatment response and prognosis. Methods CEA and CK19 mRNAs in peripheral blood were detected by Taq Man reverse transcriptase-polymerase chain reaction （RT-PCR） in 78 patients with lung cancer before and after treatment,30 patients with benign lung diseases and 30 healthy subjects. Serum CEA and CYFRA21-1 levels were also measured by enzyme linked immunosorbent assay （ELASA） in the 78 patients with lung cancer before treatment. Patients were followed up for 2 years. Results The positive rates of CEA and CK19 mRNA in patients with lung cancer were 69.2%（54/78） and 62.8%（49/78）, respectively, which were significantly higher than those in patients with benign lung diseases and the healthy controls （χ^2 were 37.65,41.54 ;27.41,30.84 respectively p〈0.01）. The positive rate of CEA mRNA was the highest in adenocarcinoma, while the positive rate of CK19 mRNA the highest in squamous cell carcinoma. There was no statistically significant difference among different stages （χ^2 were 3.63,3.81 p〈0.01 respectively）. The positive rates of CEA mRNA and CK19 mRNA were higher than those of serum CEA and CYFRA21-1. The positive rates of CEA mRNA and CK19 mRNA decreased significantly after surgical operation, but without significant change after chemotherapy. The median survival time （MST） for patients with a positive CEA mRNA before chemotherapy was shorter than those with a negative CEA mRNA （8.5 months and 11.7 months, respectively）; The MST for patients with a positive CK19 mRNA before chemotherapy was shorter than those with a negative CK19 mRNA （8.9 months and 12.3 months, respectively）. The rate of relapse and metastasis were higher in patients （29.4%） with a positive CEA mRNA preoperatively than those with a negative CEA mRNA （7.7%）. The rate of relapse and metastasis was also higher in patients with a positive CK19 mRNA preoperatively （18.8%） as compared to those with a negative PCR result （7.1%）. Conclusions CEA and CK19 mRNAs can be used as markers in the detection of tumor micrometastases in lung cancer, and in evaluating surgical response. The results suggest that the gene markers are better than the serum ones, and therefore may be useful for the early diagnosis of lung cancer.
出处
《结核病与胸部肿瘤》
2005年第4期267-271,共5页
Tuberculosis and Thoracic Tumor
关键词
逆转录聚合酶链反应
诊断
肺肿瘤
癌胚抗原
角蛋白
Reverse transcriptase polymerase chain reaction Lung neoplasms Diagnosis Carcinoembryonic antigen Keratin
