核苷酸切除修复交叉互补组1和肺耐药蛋白不同表达水平对顺铂治疗恶性胸腔积液的影响

doi:10.3969/j.issn.2095-3755.2019.03.006

摘要/Abstract

摘要：

目的探讨核苷酸切除修复交叉互补组1(excision repair cross complementing 1,ERCC1)和肺耐药蛋白(lung resistance protein, LRP)不同表达对顺铂治疗恶性胸腔积液疗效的影响。方法选取哈尔滨市胸科医院肿瘤科2016年1月至2019年6月收治的、拒绝全身化疗仅胸腔注射顺铂的恶性胸腔积液患者137例,将胸腔积液沉渣石蜡包埋切片中查见肿瘤细胞的124例纳入研究,采用免疫组织化学染色链霉菌抗生素蛋白-过氧化物酶连接法(SP法,简称“免疫组化”)行ERCC1和LRP基因检测,按患者基因组合表达的不同分为A组(ERCC1和LRP均低表达)28例、B组(ERCC1和LRP均高表达)38例,C组(ERCC1低表达且LRP高表达)35例、D组(ERCC1高表达且LRP低表达)23例,以完全缓解和部分缓解为治疗有效,比较不同基因组合表达的疗效差别。采用SPSS 18.0 统计学软件进行分析,组间计量资料的比较采用方差分析法;组间计数资料的比较采用χ ²检验;以 P<0.05为差异有统计学意义。结果 A组、B组、C组、D组胸腔注射顺铂治疗的有效率分别为85.71%(24/28),26.32%(10/38),51.44%(18/35),56.52%(13/23),4组有效率的比较差异有统计学意义(χ ²=22.995,P=0.000)。A组疗效明显高于B、C和D组(χ ²值分别为22.772、 8.229、5.403,P值分别为0.000、0.007、0.029)。B组疗效明显低于C和D组(χ ²值分别为4.860、5.566,P值分别为0.033、0.029)。C组和D组疗效相当(χ ²=0.145,P=0.197)。结论 4组疗效比较显示,A组疗效最佳,C组和D组疗效次之,B组疗效最低。ERCC1和LRP均高表达考虑对顺铂耐药,建议更换其他药品治疗。

关键词: 胸腔积液, 恶性, 基因表达, 顺铂, 疗效比较研究, 耐药基因

Abstract:

Objective To investigate the effect of different expressions of excision repair cross complementing 1 (ERCC1))and lung resistance protein (LRP) genes in the treatment of malignant pleural effusion with cisplatin.Methods One hundred and thirty-seven cases with malignant pleural effusion treated in the Oncology Department of Harbin Chest Hospital from January 2016 to June 2019 who refused systemic chemotherapy and received cisplatin injection only into the chest cavity were selected. Within them, 124 cases with tumor cells found in buried section of their pleural effusion samples were enrolled in this study. We used immunohistochemical staining of Streptomyces antibiotin protein-peroxidase ligation(SP method)(abbreviated as “immunohistochemical”) method to detect ERCC1 and LRP genes, then divided patients into 4 groups: 28 cases in group A (low expression of ERCC1 and LRP),38 cases in group B(high expression of ERCC1 and LRP), 35 cases in group C (low expression of ERCC1 and high expression of LRP) and 23 cases in group D(high expression of ERCC1 and low expression of LRP). Defining complete and partial remission as effective treatment, we compared therapeutic effectiveness among groups with different gene combinations. SPSS 18.0 statistical software was used for analysis. Comparison of metrological data between groups was conducted using single factor variance analysis;Comparison of counting data between groups was done with χ ² test. Difference less than 0.05 were considered as statistically significant. Results The topical medication effectiveness of cisplatin in group A, group B, group C, and group D were 85.71% (24/28),26.32% (10/38),51.44% (18/35) and 56.52% (13/23) respectively. Difference between those four groups was statistically significant (χ ²=22.995,P=0.000).The curative rate of group A was higher than that of groups B, C and D (χ ²=22.772,8.229,5.403;P=0.000,0.007,0.029). Curative rate of group B was significantly lower than groups C and D (χ ²=4.860,5.566;P=0.033,0.029).Group C and group D were of equivalent effectiveness (χ ²=0.145,P=0.197). Conclusion The curative effectiveness of 4 groups showed that group A got the best effectiveness, group C and group D had the second best curative effect, and group B had the lowest curative effect. For patients with highly expressed ERCC1 and LRP, we should consider resistance to cisplatin and recommend replacing cisplatin with other drugs.

Key words: Pleural effusion, malignant, Gene expression, Cisplatin, Comparative effectiveness research, Resistance genes

常丽,林红,孙素芹,庞有铨,边楠楠,甄春英,关雪晴,杨浩,刘雪梅. 核苷酸切除修复交叉互补组1和肺耐药蛋白不同表达水平对顺铂治疗恶性胸腔积液的影响[J]. 结核病与肺部健康杂志, 2019, 8(3): 178-182. doi: 10.3969/j.issn.2095-3755.2019.03.006

CHANG Li,LIN Hong,SUN Su-qin,PANG You-quan,BIAN Nan-nan,ZHEN Chun-ying,GUAN Xue-qing,YANG Hao,LIU Xue-mei. Effect of different expressions of ERCC1 and LRP performed on the effectiveness of cisplatin in the treatment of malignant pleural effusion[J]. Journal of Tuberculosis and Lung Health, 2019, 8(3): 178-182. doi: 10.3969/j.issn.2095-3755.2019.03.006

图/表 2

表1

患者一般情况在4个组中的分布情况

一般情况	A组(28例)	B组(38例)	C组(35例)	D组(23例)	合计(124例)	检验值	P值
年龄(岁, $x ˉ$ ±s)	61.71±10.93	63.16±11.69	62.57±12.25	61.3±10.63	62.32±11.38	F=0.159	0.924
性别[例(构成比,%)]						χ²=2.193	0.533
男	12(42.86)	18(47.37)	20(57.14)	9(39.13)	59(47.58)
女	16(57.14)	20(52.63)	15(42.86)	14(60.87)	65(52.42)
原发病[例(构成比,%)]						χ²=0.681	0.995
肺癌	22(78.57)	28(73.68)	27(77.14)	18(78.26)	95(76.61)
胸膜间皮瘤	4(14.29)	6(15.79)	4(11.43)	3(13.04)	17(13.71)
其他	2(7.14)	4(10.53)	4(11.43)	2(8.70)	12(9.68)

表1

表2

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