肺癌相关癌性脑膜炎患者脑脊液中TP53基因突变及其临床观察  

Cerebrospinal fluid TP53 gene mutation in patients with lung cancer associated meningitis and its clinical implications

作　　者：李晓庆 黄敏 陈鑫鑫 邹月丽[1] 燕犁天 赵辉[1] 何俊瑛[1] 卜晖[1] Li Xiaoqing;Huang Min;Chen Xinxin;Zou Yueli;Yan Litian;Zhao Hui;He Junying;Bu Hui(Department of Neurology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院神经内科,石家庄050000

出　　处：《中华医学杂志》2020年第11期823-827,共5页National Medical Journal of China

基　　金：国家重点研发计划(2017YFC0904503)。

摘　　要：目的观察脑脊液TP53基因突变在肺癌相关癌性脑膜炎中的作用。方法选取2015年12月至2018年12月就诊于河北医科大学第二医院的35例确诊为肺癌相关癌性脑膜炎患者进行回顾性分析。所有患者均行脑脊液二代测序得出TP53基因为突变型或野生型,其中TP53基因突变型患者有23例,TP53基因野生型患者有12例。观察两组间患者的临床特征、脑脊液常规、生化、KPS评分及总生存期间的差异。结果两组在临床表现上均以头痛、恶心呕吐症状为主;两组间在脑脊液压力、白细胞、生化及KPS评分方面均无统计学意义;TP53基因突变型组原发灶确诊至脑膜转移平均时间明显短于TP53基因野生型组(5.79个月比25.5个月);TP53基因突变型组中患者自原发灶确诊至观察终点的中位生存时间为19.77个月,TP53基因野生型组中患者自原发灶确诊至观察终点的中位生存时间为88.73个月,差异有统计学意义(P=0.043)。结论肺癌相关癌性脑膜炎患者的脑脊液中可检测到抑癌基因TP53的基因突变,存在该基因突变的患者较早发生脑膜转移且中位生存期较短。Objective To observe the role of cerebrospinal fluid(CSF)TP53 gene mutation in lung cancer associated meningitis.Methods A retrospective analysis was performed on 35 patients diagnosed with lung cancer associated meningitis at the Second Hospital of Hebei Medical University from December 2015 to December 2018.All patients underwent the next-generation sequencing of CSF,and TP53 gene was found to be mutant or wild type,including 23 patients with TP53 mutant type and 12 patients with TP53 wild type.The clinical characteristics,CSF leukocyte,protein,glucose,chloride,Karnofsky performance(KPS)and overall survival were observed.Results Headache,nausea and vomiting were the main clinical manifestations in both groups.There were no significant differences in CSF pressure,leukocyte,biochemical indicators and KPS between the two groups.The average time from diagnosis of lung cancer to diagnosis of lung cancer associated meningitis in the TP53 mutant group was significantly shorter than that in the TP53 wild type group(5.79 months vs 25.5 months).The median survival time of patients in the TP53 mutant group from lung cancer diagnosis to the observation endpoint was 19.77 months,while it was 88.73 months in the TP53 wild type group,and the difference was statistically significant(P=0.043).Conclusions Mutation in the tumor suppressor gene TP53 can be detected in the CSF of patients with lung cancer associated meningitis.Patients with such mutation have earlier meningeal metastasis and shorter median survival time.

关 键 词：肺癌相关癌性脑膜炎 TP53基因 脑脊髓液 

分 类 号：R734[医药卫生—肿瘤] R742[医药卫生—临床医学]