【摘要】 目的分析非小细胞肺癌(NSCLC)患者围手术期外周血中肺组织特异性基因(LUNX)mRNA的表达与肺癌微转移的相关性,并探讨肺癌根治术中肺血管结扎顺序对LUNX mRNA表达的影响。方法 120例临床可行肺癌根治术的Ⅰ、Ⅱ期和部分ⅢA期(T3N1~2M0)NSCLC患者被纳入实验组,所有患者术前检查均明确无远处转移病灶。术前将患者随机分为静脉组(先结扎肺静脉)及动脉组(先结扎肺动脉)各60例,分别于术前、术中、术后第7日抽取外周血,采用逆转录PCR(RT-PCR)检测其外周血LUNX mRNA的表达情况。另选取60名健康体检者及30例肺部良性疾病需行肺叶切除患者为对照组,同法检测外周血LUNX mRNA的表达情况。结果实验组术前、术中、术后LUNX mRNA表达阳性率分别为47%、61%及20%。静脉组与动脉组术前LUNX mRNA表达阳性率比较差异无统计学意义(P>0.05);动脉组术中LUNX mRNA表达阳性率明显较术前高(P=0.017);术后2组LUNX mRNA表达阳性率均较术前低(P<0.001、P=0.022)。2组内术前不同TNM分期之间LUNX mRNA表达阳性率比较差异均有统计学意义(P=0.015、P=0.004),LUNX mRNA表达阳性率均随分期上升而升高。术前2组间不同TNM分期LUNX mRNA表达阳性率比较差异均无统计学意义(P均>0.05);术中动脉组不同TNM分期的LUNX mRNA表达阳性率均高于静脉组,但比较差异无统计学意义(P均>0.05);术后,在Ⅰ、Ⅱ期肺癌患者中,2组LUNX mRNA表达阳性率比较差异均无统计学意义(P均>0.05),而在ⅢA期患者中,动脉组术后LUNX mRNA表达阳性率显著高于静脉组(P=0.011)。对照组均无LUNX mRNA表达阳性者。结论手术治疗有助于抑制肺癌微转移,但仍有部分患者有肺癌微转移可能,仍存在术后癌灶复发、转移的风险;肺癌根治术中应采用先结扎肺静脉的顺序;LUNX mRNA的表达也与TNM分期有关。更多还原

【Abstract】 Objective To explore the relationship of lung-specific X protein( LUNX) evel in hip mRNA level in peripheral blood and micro-metastasis of lung cancer during perioperative period in patients with non-small cell lung cancer( NSCLC) and assess the influence of sequence of pulmonary vessel ligation upon LUNX mRNA expression during radical resection of pulmonary carcinoma. Methods A total of 120 patients with TNM stage Ⅰ,Ⅱ and ⅢA( T3N1 ~ 2M0) NSCLC suitable for undergoing radical resection of pulmonary carcinoma were allocated into the experimental group. All patients had no distant metastasis confirmed by preoperative examination. Prior to surgery,all patients were randomly divided into the vein( they were first given pulmonary venous ligation,n = 60) and artery groups( they were first given pulmonary arterial ligation,n =60). Peripheral blood sample was collected before,during and at 7 d after operation. The expression level of LUNX mRNA in peripheral blood was detected by RT-PCR. Another 60 healthy subjects and 30 individuals with benign lung diseases requiring lobectomy were allocated into the control group,the expression level of LUNX mRNA in peripheral blood was equally measured. Results The positive rate of LUNX mRNA expression in the experimental group was 47%,61% and 20% before,during and after surgery,respectively. Preoperative positive rate of LUNX mRNA expression did not significantly differ between the vein and artery groups( P > 0. 05). Intraoperative positive rate of LUNX mRNA expression was significantly higher compared with preoperative level in the artery group( P = 0. 017). Postoperative positive rate of LUNX mRNA expression was significantly lower than preoperative positive rate in both groups( P < 0. 001,P = 0. 022). In two groups,preoperative positive rates of LUNX mRNA expression significantly differed among different TNM stages( P =0. 015,P = 0. 004). The positive rate of LUNX mRNA expression was elevated along with TNM stage. Preoperative positive rates of LUNX mRNA expression among different TNM stages did not significantly differ between two groups( all P > 0. 05). Intraoperative positive rates of LUNX mRNA expression among different TNM stages in the artery group was higher compared with that in the vein group with no statistical significance( all P >0. 05). For patients diagnosed with stage Ⅰ and Ⅱ lung cancer,postoperative positive rates of LUNX mRNA expression did not significantly differ between two groups( both P > 0. 05),whereas postoperative positive rate of LUNX mRNA expression in the artery group was significantly higher than that in the vein group for those with TNM Sstage ⅢA lung cancer( P = 0. 011). No subjects in the control group expressed LUNX mRNA. Conclusions Surgical treatment contributes to inhibiting micro-metastasis of lung cancer. However,partial patients still have the possibility of lung cancer micro-metastasis,lesion recurrence and metastasis still exists.Pulmonary vein should be ligated before pulmonary artery in radical resection of NSCLC. The expression of LUNX mRNA is equally correlated with TNM stage.更多还原