【摘要】 目的探讨99Tcm-甲氧基异丁基异腈断层双时相显像(99Tcm-MIBI SPECT)与乳腺癌肿块血液中转移-黏附基因(MTDH)之间的关系。方法选择2010年9月—2012年11月南华大学附属南华医院收治的72例乳腺癌患者为研究组,同期112例乳腺良性肿块患者为对照组,分别于注射99Tcm-MIBI 5 min后采集早期相、180 min后采集延迟相平面像,明确99Tcm-MIBI SPECT的阳性标准;收集乳腺活检后肿块内血液,应用反转录-聚合酶链反应(RT-PCR)检测MTDH的mRNA表达,明确乳腺癌不同病理分期MTDH的mRNA表达情况;分析乳腺癌患者99Tcm-MIBI SPECT显像和肿块内血MTDH mRNA表达的关系。结果 (1)99Tcm-MIBI SPECT显示,对照组和研究组99Tcm-MIBI SPECT早期相T/NT间差异有统计学意义〔(1.94±1.55)和(4.82±4.13),t=6.691,P<0.001〕;研究组早期相和延迟相T/NT间差异无统计学意义〔(4.82±4.13)和(6.56±10.95),t=1.262,P=0.209〕。据此99Tcm-MIBI SPECT阳性标准可确立。(2)不同病理分期的乳腺癌患者肿块血MTDH mRNA表达量间差异有统计学意义(P<0.001),且Ⅳ期高于Ⅲ期(P<0.05),Ⅲ期高于Ⅱ期(P<0.05),Ⅱ期和Ⅰ期间差异无统计学意义(P>0.05)。(3)99Tcm-MIBI SPECT对乳腺癌患者MTDH mRNA表达的阳性预测值为96.8%,阴性预测值为66.7%,敏感度为95.3%,特异度为75.0%。一致性检验显示,99Tcm-MIBI SPECT和肿块内血MTDH mRNA表达量的Kappa系数为0.67。结论 RT-PCR检测乳腺肿块血MTDH mRNA的表达,可有效预测中-晚期乳腺癌患者病理分期和预后;99Tcm-MIBI SPECT对乳腺癌MTDH的表达有较高的阳性预测值、敏感度和特异度,可用于乳腺癌化疗耐药和内分泌耐药的评估,可为MTDH的靶向性治疗提供依据,但需注意99Tcm-MIBI SPECT对乳腺癌MTDH表达的阴性预测值较低。临床试验注册注册机构为中国临床试验注册中心,注册号为ChiCTR-DDT-09000356。更多还原

【Abstract】 Objective To study the relationship of 99Tcm-MIBI SPECT to MTDH mRNA expression in breast tumor residual blood. Methods A retro spective analysis was performed in breast tumor patients admitted to this hospital from September 2010 to November 2012. Early phase plane image was collected 5 min after 99Tcm-MIBI injection,lag phase collected 180min after 99Tcm-MIBI in groups study( patients with breast cancers,n = 72) and control( patients with benign breast tumors,n = 112). The positive standard of 99Tcm-MIBI SPECT was confirmed. The residual blood in tumor masses was collected,mRNA of MTDH detected by reverse transcription-polymerase chain reaction( RT-PCR),MTDH mRNA expressions at different pathological stages determined. The relationship of 99Tcm-MIBI SPECT image to MTDH mRNA expressions was analyzed. Results( 1) By 99Tcm-MIBI SPECT,there was significant difference in control group and early phase of study group T / NT〔( 1. 94 ±1. 55) vs.( 4. 82 ± 4. 13),t = 6. 691,P < 0. 001〕,there was no in early or late phase of study group N/NT〔( 4. 82 ±4. 13) vs.( 6. 56 ±10. 95),t =1. 262,P =0. 209〕. On these grounds 99Tcm-MIBI SPECT positive standards were established.( 2) There was difference in MTDH mRNA expression between breast tumor residual blood at different pathological stages( P < 0. 001),MTDH mRNA expression was higher at Ⅳ stage than at Ⅲ stage( P < 0. 05),higher at Ⅲ stage than atⅡ stage,but there was no difference between Ⅱ stage or Ⅰ stage( P > 0. 05).( 3) The positive predictive value,negative predictive value,sensitivity,specificity of 99Tcm-MIBI SPECT for MTDH mRNA expression were 96. 8%,66. 7%,95. 3%,75. 0%,respectively. By consistency check,the Kappa coefficient of 99Tcm-MIBI SPECT and NTDH mRNA was 0. 67. Conclusion RT-PCR detecting residual blood MTDH mRNA expression can predict effectively the pathological stages and prognoses of metaphase or advanced breast cancer patients. The 99Tcm-MIBI SPECT has high positive predictive value,sensitivity,specificity for MTDH expression,which can be used to evaluate the drug resistances of chemical therapy and endocrine and provide a base for MTDH targeted therapy,but it has a low negative predictive value.更多还原