替莫唑胺对脊髓胶质瘤的疗效及对MGMT、 Survivin和caspase-3的影响  

Effect of microsurgical resection combined with temozolomide on glioma and its effect on MGMT,Survivin and caspase-3

作　　者：胡国良[1] 李全春[1] 朱强[1] 衣志刚[1] 张远征[1] HU Guo-liang;LI Quan-chun;ZHU Qiang;YI Zhi-gang;ZHANG Yuan-zheng(Department of Neurosurgery,Affiliated Hospital of Yan′an University,Yan′an 716000,China)

机构地区：[1]延安大学附属医院神经外科,陕西延安716000

出　　处：《延安大学学报（医学科学版）》2020年第4期29-33,共5页Journal of Yan'an University:Medical Science Edition

摘　　要：目的研究替莫唑胺对脊髓胶质瘤的临床疗效,并通过细胞研究检测其对MGMT、Survivin和caspase-3的影响,探讨其抑制复发和转移的机制。方法选取我院于2015年1月至2019年5月收治的80例脊髓胶质瘤患者,依据随机数字表法分为观察和对照两组,每组40例。两组患者均在神经电生理监测下采用显微外科切除,而观察组联合替莫唑胺治疗。比较两组患者治疗后的肿瘤切除率、McCormick神经功能以及复发、生存情况。观察组术后给予替莫唑胺治疗观察两组的肿瘤复发和生存情况。术中取患者脊髓胶质瘤细胞,体外培养检测替莫唑胺对凋亡蛋白caspase-3、MGMT、Survivin基因表达情况的影响。结果两组患者的全切率、次切率、部分切除率差异无统计学意义(P>0.05),而替莫唑胺治疗组患者的复发率显著低于对照组(P<0.05)。治疗3个月后,两组患者的McCormick神经功能差异无统计学意义(P<0.05)。随访一年观察组患者死亡率为5.00%(2例),显著低于对照组(9例,22.50%),差异有统计学意义(P<0.05)。细胞实验表明随着替莫唑胺浓度的增加,细胞侵袭能力下降,显著低于空白对照组(P<0.05),而脊髓胶质瘤细胞凋亡蛋白Caspase3表达增加,替莫唑胺组Survivin基因表达阳性率低于空白对照组(P<0.05),MGMT表达阳性率略低于空白对照组,差异无统计学意义(P>0.05)。结论替莫唑胺可增加神经电生理监测下显微外科切除术后脊髓胶质瘤的治疗效果,其机制可能与增加caspase-3活性和抑制Survivin基因表达有关,从而降低术后复发率和死亡率。Objective To study the effect of microsurgical resection combined with temozolomide on glioma and its effect on MGMT,Survivin and caspase-3 under electrophysiological monitoring.Methods 80 patients with spinal glioma were admitted in our hospital from January 2015 to May 2019,and were divided into two groups:observation group and control group,40 cases in each group.Both groups were treated with neurosurgery under neurophysiological monitoring,while the observation group was treated with temozolomide.The tumor resection rate,McCormick nerve function and recurrence were compared between the two groups after treatment,and the activity of temozolomide on glioma cell apoptosis protein caspase-3,primary tumor cell metastasis ability and the expression MGMT and Survivin were compared,and the survival curves of the patients were drawn.Results There was no significant difference in total cut rate,secondary cut rate and partial resection rate between the two groups(P>0.05),but the recurrence ratein the observation group was significantly lower than that in the control group(P<0.05).There was no significant difference in McCormick nerve function between the two groups after 3 months of treatment(P<0.05).After one year′s follow-up,the mortality rate of the observation group was 5.00%(2 cases),which was significantly lower than that of the control group(9 cases,22.50%),the difference was statistically significant(P<0.05).With the increase of temozolamide concentration,the invasiveness of glioma cells was decreased,which was significantly lower than that of control group(P<0.05),while the apoptotic protein Caspase 3 in glioma cells was increased.The positive rate of Survivin expression in temozolomide group was significantly lower than that in control group(P<0.05),and the positive rate of MGMT expression was lower than that of blank control group(P>0.05).Conclusion Temozolomide can increase the therapeutic effect of microsurgical resection under neuroelectrophysiological monitoring on spinal glioma,and its mechanism may be

关 键 词：神经电生理监测 替莫唑胺 脊髓胶质瘤 MGMT SURVIVIN CASPASE-3 

分 类 号：R739.42[医药卫生—肿瘤]