宫颈癌术前联合重组人p53腺病毒注射液及放射治疗的有效性  

Efficacy of Combined rhAd-p53 and Radiotherapy in Cervical Cancer Patients

作　　者：李雪梅 郑丽娥[1] 王金华[1] 何春妮 LI Xuemei;ZHENG Li′e;WANG Jinhua;HE Chunni(Department of Gynecology and Obstetrics, The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005, China;900 Hospital of the Joint Logistics Team,Fuzhou 350003, China)

机构地区：[1]福建医科大学附属第一医院妇产科,福州350005 [2]中国人民解放军联勤保障部队第九○○医院,福州

出　　处：《福建医科大学学报》2020年第1期13-17,共5页Journal of Fujian Medical University

基　　金：福建省自然科学基金(2014J01428)。

摘　　要：目的评价宫颈癌术前联合重组人p53腺病毒注射液(rhAd-p53注射液)及放射治疗的有效性。方法宫颈癌患者50例分为GTRT组(n=20)和RT组(n=30),GTRT组采用rhAd-p53注射液+后装照射+手术治疗,RT组采用后装照射+手术治疗。观察两组患者非手术治疗前后局部肿瘤消退情况、术后累积生存率及无瘤生存率。采用TUNEL法检测两组术后宫颈癌组织细胞凋亡情况,免疫组织化学检测凋亡相关蛋白P53,BCl-2,Bax及Caspase-3的表达情况。结果治疗后两组肿瘤面积均明显缩小(P<0.01),组间比较差别无统计学意义(P>0.05);两组术后1年内生存率无差异,术后2,5年及5年以上生存率,GTRT组明显高于RT组;GTRT组的凋亡指数及Caspase-3染色均高于RT组(P<0.01),P53蛋白则低于RT组(P<0.01)。两组的Bcl-2及Bax蛋白表达量差别无统计学意义(P>0.05)。结论宫颈癌患者瘤内注射rhAd-p53注射液治疗有效,与后装照射有协同作用。Objective To evaluate the efficacy of combined recombinant adenovirus-p53(Gendicine,rhAd-p53)and radiotherapy in cervical cancer patients.Methods 50 cervical cancer patients were enrolled.Subjects were divided into GTRT group(n=20)and RT group(n=30).RT group received radiation+surgical treatment while GTRT group received radiation with rhAd-p53+surgery.Local tumor regression after non-surgical treatment,postoperative cumulative survival rates and disease-free survival were observed between the two groups.Removed cervical cancer tissue was pathologically examined.Apoptosis was assessed by terminal deoxynucelotidyl-transferase-mediated dUTP nick-end-labeling(TUNEL)method,protein expression of anti-apoptotic and pro-apoptotic protein of mitochondria apoptosis pathway(such as P53,Caspase-3,BCl-2 and Bax)in cervical cancer were determined by immunohistochemical.Results The volune of tumors in GTRT group were reduced more than RT group,and there was no statistically significant difference between them(P>0.05).Postoperative cumulative survival rate:the 1year survivals of GTRT group and RT group were all 100%.The 2-,5-year and longer survival were higher in the GTRT group than in the RT group and difference was significant(P<0.05).TUNEL staining and apoptosis-related protein expression analysis showed that the apoptotic index was significantly higher in the GTRT group compared to the RT group.The expression of Caspase-3 protein was significantly higher in the GTRT group compared to the RT group.The protein expression of P53 was lower in the GRTR group than in the RT group.The protein expression of Bcl-2 and Bax in the GRTR group showed no significant difference than the RT group(P>0.05).Conclusions In general,adenovirus-p53 treatment is a promising gene therapy and works as a radiosensitizer in radiotherapy of cervical cancer.

关 键 词：宫颈肿瘤 细胞凋亡 肿瘤抑制蛋白质P53 原癌基因蛋白质类 半胱氨酸天冬氨酸蛋白酶 

分 类 号：R452[医药卫生—治疗学] R737.33[医药卫生—临床医学]