止凝血分子标志物监测在乳腺癌诊治中的意义  

Clinical study of hemostatic molecular markers in the patients with breast cancer

作　　者：焦洁茹[1] 楼谷音[2] 吴方[1] 王学锋[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院老年病科 [2]上海交通大学医学院附属瑞金医院检验科

出　　处：《诊断学理论与实践》2006年第5期394-397,共4页Journal of Diagnostics Concepts & Practice

摘　　要：目的:观察乳腺癌止凝血分子标志物的变化,以探讨其在疾病诊治及预后判断中的意义。方法:采用逆转录、实时定量PCR技术,检测30例乳腺癌组织中组织因子(TF)mRNA水平;用ELISA法同步检测患者血浆止凝血分子标志物含量,包括TF、组织因子途径抑制物(TFPI)、凝血酶-抗凝血酶复合物(TAT)、组织型纤溶酶原激活剂(t-PA)、尿激酶型纤溶酶原激活剂(u-PA)、尿激酶型纤溶酶原激活剂受体(u-PAR)、纤溶酶-抗纤溶酶复合物(PAP)等。结果:术前乳腺癌组血浆TF、TAT、u-PA、u-PAR、PAP含量均较正常对照组明显升高,其中有局部浸润、淋巴结肿大、远处脏器转移者的u-PA、u-PAR升高更为显著;TFmRNA在肿瘤细胞表达显著增高。术后TF、u-PA虽较术前有明显下降,但在Ⅲ、Ⅳ期患者仍高于正常。结论:乳腺癌患者体内同时存在凝血、纤溶功能异常,表现为组织因子表达增高,凝血酶生成增加,纤溶酶原激活物大量释放。术后患者仍处于高凝状态。而纤溶功能亢进可能是其易播散、浸润的主要原因之一。逆转录实时定量PCR技术,使TFmRNA有望成为临床上乳腺癌病情监测及预后判断的辅助指标。Objective To study the changes of hemostatic molecular markers in the patients with breast cancer for elucidating their clinical significance. Methods The plasma levels of tissue factor （TF）, tissue factor pathway inhibitor （TFPI）, thrombin anti-thrombin complex （TAT）, t-PA （tissue type plasminogen activator） urokinase type plasminogen activator （u-PA）, urokinase type plasminogen activator receptor （u-PAR） and plasim-antiplasim complex （PAP） were measured by ELISA. The TF mRNA level was detected by Real-time RT-PCR. Results The plasma levels of TF, TAT, u- PA, u-PAR and PAP before the operation elevated in the breast cancer patients in comparison with the healthy controls, with significantly higher levels of u-PA and u-PAR in the patients with lymph node involvement or distal metastasis. The TF mRNA level was higher in the breast cancer compared with that in the normal tissue. After the operation, the levels of TF and u-PA remained high in the breast cancer patients with Ⅲ or Ⅳ stage. Conclusions Abnormalities of coagulation and fibrolysis exist simultaneously in the patients with breast cancer, manifesting over-expression of TF, increased formation of thrombin and over-released plasminogen. Hypercoagulability still exists after the operation. Hyperfibrinolysis seems an important factor associated with metastasis and invasion of breast cancer. Quantitative detection of TF gene expression by the method of real-time RT-PCR is feasible as a monitoring and predicting marker for breast cancer.

关 键 词：逆转录实时定量PCR 乳腺癌 凝血 纤溶 

分 类 号：R737.9[医药卫生—肿瘤]