【作者】 宋文华；

【导师】 刘弋； 王瑞祥； 于东风；

【作者基本信息】 安徽医科大学 ， 外科学， 2005， 硕士

【摘要】 目的 胃癌是我国常见的恶性肿瘤之一,其病死率居各种恶性肿瘤之首,早期发现、早期诊断对胃癌的防治具有重要意义。现有的检查手段具有一定的局限性,寻找有效的诊断方法是降低胃癌死亡率的关键措施之一。研究发现,检测正常细胞恶性转化产生的肿瘤标志物(Tumor Markers,TM)水平在肿瘤的诊断、疗效监测、预后判断等方面均具有重要价值,而且具有检测简便、快速、便于动态监测等优点,是目前肿瘤研究的热点之一。血清胃蛋白酶原(Serum Pepsinogen,SPG)是胃黏膜特异性功能酶——胃蛋白酶的无活性前体,人PG可分为两种生化和免疫活性特征不同的亚群:PGⅠ和PGⅡ,SPG的变化能够反应出胃黏膜的形态和功能改变,联合测定PGⅠ,PGⅡ可以起到胃体黏膜“血清学活检”的作用。糖类抗原72-4(Carbohydrate Antigen72-4,CA72-4)属糖蛋白类癌胚抗原,由乳腺癌肝转移细胞的细胞膜成分免疫小鼠所得,对恶性肿瘤特异性高,在健康人和良性疾病患者血液中极少出现,对癌症的正确诊断具有一定价值。胃癌抗原(Monoclonal gastric cancer antigen,MG7Ag)是由鼠源性抗人胃癌单克隆抗体MG7发现的胃肠道肿瘤相关抗原,办属糖蛋白抗原,对胃癌有较高的敏感性和特异性。本研究通过检测分析PGⅠ,PGⅡ,CA72-4,MG7Ag四种指标在胃癌患者血清中的含量,并与正常人、慢性浅表性胃炎、慢性萎缩性胃炎、胃溃疡患者血清中的含量作对比来评价上述指标单独及联合检测用于诊断胃癌的价值,为寻找胃癌理想的分子生物学诊断方法提供理论依据。同时分析血清PGⅠ,PGⅡ,CA72-4,MG7Ag表达水平与胃癌临床生物学行为的关系,研究其在胃癌侵袭转移和预后中的作用,为防止胃癌转移、判断疗效以及寻找肿瘤治疗的新靶点等提供理论依据。 方法 选取2004年10月～2005年3月在蚌埠医学院第一附属医院、第二附属医院外科及门诊就诊的胃癌患者33例,慢性浅表性胃炎18例,慢性萎缩性胃炎7例、胃溃疡12例及正常对照组20例的血清,应用免疫放射分析法(IRMA)或酶联免疫吸附试验法(ELISA)对90例血清PGⅠ,PGⅡ,CA72-4,MG7Ag含量进行检测,通过组间各指标血清含量的对比,研究胃癌患者血清PGⅠ,PGⅡ,CA72-4,MG7Ag单独和联合检测更多还原

【Abstract】 Objective: The mortality of gastric carcinoma, one of the familiar malignant tumor, stands first on the list. It is important to detect and diagnose in nonage in order to prevent and cure gastric carcinoma. The examine ways existing have limitation, accordingly, to find an effective diagnosis method is one of the key steps which can depress mortality. The malignant inversion of normal cell engenders new tumor marks. Nowadays,the particular antigen is the focus of study, for it not only plays an important role in diagnosis,clinical curative effect monitor and prognosis judgement, but also has the merit that the check and measure is handy,celerity and the dynamic monitor is easy. Pepsinogen (PG) is an inactive precusor of pepsinspecial functional enzyme of gastric mucosa. Human PG can be divided into two subgroups with different characters of biochemistry and immunocompetence: PG I and PG II .The level of serum PG can reflect the morphological and functional status of the gastric mucosa,and combined determination of PG I and PG II can be called "serologic biopsy".CA72-4, which belongs to glycoprotein carcino-embryonic antigen, was obtained from immune rats by the membrane content of liver cancer that metastasized from mammary cancer. CA72-4 has a high specificity to malignant tumor, it appears iota in blood of healthy or benign tumor patient, as a result, it has some value to judge cancer correctly. MG7Ag is an antigen relevant to limentary canal tumor that freshly found by a haploid clone antibody MG7 resisted human gastric carcinoma which originated from rat, it belongs to glycoprotein antigen and has a upper sensitivity and specificity to gastric carcinoma. In this experiment, in order to provide the theoretical foundation for searching for an ideal molecular biology diagnose method of gastric carcinoma, we test the expression of four tumor marks PG I ,PG II ,CA72-4 and MG7Ag in serum of gastric carcinoma ,comparethe contents with those in serum of chronic superficial gastritis,chronic atrophic gastritis,gastric ulcer and normal controls and analyze the relationship with the biology behavior of gastric carcinoma to discuss the role of them in invasion,metastasis and prognosis of gastric carcinoma, and provide the theoretical foundation for clinical early-warning of metastasisjudgement of curative effect and searching for a new target of neoplasm clinical therapy.Methods: In this experiment,we select the serum specimens of33 gastric carcinoma patients ,of 18 chronic superficial gastritis patients, of 7 chronic atrophic gastritis patients, of 12 gastric ulcer patients and of 20 normal people hospitalized in surgical department or treated at outpatient department of the 1st and2nd affiliated hospital of BengBu Medical College from 2004.10 to 2005.3. Using the Immuno radiometrec assay (IRMA) or Enzyme-linked immunosorbent assay (ELISA) ,the expressions of PG I ,PG II ,CA72-4 and MG7Ag in serum specimens were tested to study the correlation between the expression levels of these four indices and their diagnosis values by single test or unite test and analyze the relationship between the expressions of them and clinical biology of gastric carcinoma.Results: l.The serum concentrations of PG I and PG IIin gastric carcinoma are remarkably lower than those in control and the serum concentrations of CA72-4, MG7Ag in gastric carcinoma are significantly higher than those in control (P< 0.05).2.The respective positive expression rates of PG I , PG II ,CA72-4,MG7Ag in serum is 33.33%,69.70%,39.39%,51.52%othe positive rates of the unite test of index are as follows,PGI+PG II is 69.70%,PGI+CA72-4 is 57.58%,PGI+MG7Ag is 69.70%, PGII+CA72-4 is 87.88%,PGII+MG7Ag is 90.91%,CA72-4+MG7Ag is 72.73%,PGI+ PGII+CA72-4 is 87.88%, PGI+PGII+MG7Ag is 90.91%, PGI+CA72-4+MG7Ag is 78.79%,PG II+CA72-4+MG7Ag is 93.94%,the positive rate of the unite test of four更多还原