TURBT术联合膀胱灌注对高危NMIBC患者血清IGF-1、IGFBP-3、尿NMP22水平及复发率的影响  

Effect of TURBT combined with bladder perfusion on serum IGF-1,IGFBP-3 and urinary NMP 22 levels,and recurrence rate in high-risk NMIBC patients

作　　者：任艳军 岳永俊 晋瑞娜 尉永太 REN Yan-jun;YUE Yong-jun;JIN Rui-na(Department of Urology,Changzhi People's Hospital Affiliated to Changzhi Medical College,Changzhi Shanxi 046000,China;Department of Urology,Heji Hospital Affiliated to Changzhi Medical College,Changzhi Shanxi 046000,China;Central Laboratories,Changzhi People's Hospital Affiliated to Changzhi Medical College,Changzhi Shanxi 046000,China)

机构地区：[1]长治医学院附属长治市人民医院泌尿外科,山西长治046000 [2]长治医学院附属和济医院泌尿外科,山西长治046000 [3]长治医学院附属长治市人民医院中心实验室,山西长治046000

出　　处：《临床和实验医学杂志》2023年第21期2307-2311,共5页Journal of Clinical and Experimental Medicine

基　　金：山西省卫生计生委科研项目(编号:20200501685)。

摘　　要：目的探究经尿道膀胱肿瘤电切除手术(TURBT)联合膀胱灌注对高危非肌层浸润性膀胱癌(NMIBC)患者血清胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白-3(IGFBP-3)及尿核基质蛋白22(NMP22)水平及复发率的影响。方法前瞻性选取2021年1月至2022年12月长治医学院附属长治市人民医院、长治医学院附属和济医院收治的高危NMIBC患者136例,按照信封法将其分为两组,每组各68例。对照组患者行TURBT加术后0.9%氯化钠溶液持续膀胱冲洗7 d,观察组患者行TURBT联合吉西他滨膀胱灌注治疗。记录比较两组患者手术前后血清IGF-1、IGFBP-3、尿NMP22水平及免疫功能指标的差异,并对比分析复发和并发症情况。结果手术后,两组患者的血清IGF-1、IGFBP-3水平均较手术前升高,尿NMP22水平均较手术前降低,且观察组患者的血清IGF-1、IGFBP-3水平分别为(184.56±33.12)ng/mL、(4.37±0.98)μg/mL,高于对照组[(171.56±33.15)ng/mL、(4.03±0.87)μg/mL],尿NMP22水平为(13.51±1.46)U/mL,低于对照组[(18.99±3.66)U/mL],差异均有统计学意义(P<0.05)。手术后,两组患者的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均较手术前升高,CD8^(+)水平均较手术前降低,且观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平分别为(45.59±4.56)%、(39.46±4.12)%、1.98±0.22,高于对照组[(40.78±4.78)%、(36.98±5.46)%、1.56±0.22],CD8^(+)水平为(21.26±2.16)%,低于对照组[(24.15±2.36)%],差异均有统计学意义(P<0.05)。对患者进行6个月的随访,观察组复发率为19.12%(13/68),对照组复发率为30.887%(21/68),组间比较差异无统计学意义(P>0.05)。观察组的并发症发生率为8.82%(6/68),对照组的并发症发生率为11.76%(8/68),组间比较差异无统计学意义(P>0.05)。结论TURBT联合吉西他滨膀胱灌注疗法可升高IGF-1、IGFBP-3水平,降低尿NMP22水平,显著改善高危NMIBC患者的免疫功能,且不会对患者术后复发及并发症的发生产生负面影响。Objective To explore the effect of transurethral resection of bladder tumors(TURBT)and bladder perfusion on serum insulin-like growth factor-1(IGF-1),insulin-like growth factor binding protein-3(IGFBP-3),urinary nuclear matrix protein 22(NMP22)levels,and recurrence rate in high-risk non-muscle invasive bladder cancer(NMIBC).Methods A total of 136 high-risk NMIBC patients admitted to Changzhi People's Hospital affiliated with Changzhi Medical College and Heji Hospital affiliated with Changzhi Medical College from January 2021 to December 2022 were divided into two groups according to the envelope method,with 68 patients in each group.The control group patients received TURBT and TURBT and 0.9%sodium chloride solution for 7 days after surgery,while the observation group patients received TURBT combined with gemcitabine bladder irrigation treatment.The differences of serum IGF-1,IGFBP-3,urinary NMP22 levels and immune function indexes before and after surgery between the two groups were recorded and compared.And the recurrence and complications were compared and analyzed between the two groups.Results After surgery,the levels of serum IGF-1 and IGFBP-3 in two groups were higher than those before surgery,while the level of urine NMP22 were lower than those before surgery,and the levels of serum IGF-1 and IGFBP-3 in the observation group were(184.56±33.12)ng/mL and(4.37±0.98)μg/mL,respectively,which were higher than those in the control group[(171.56±33.15)ng/mL,(4.03±0.87)μg/mL],the level of urine NMP22 was(13.51±1.46)U/mL,which was lower than that in the control group[(18.99±3.66)U/mL],and the differences were statistically significant(P<0.05).After surgery,the levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in two groups were higher than those before surgery,while the levels of CD8^(+)was lower than that before surgery,the levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in the observation group were(45.59±4.56)%,(39.46±4.12)%,and 1.98±0.22,respectively,which were higher than those in the control group[(40.78±

关 键 词：经尿道膀胱肿瘤电切术 膀胱灌注 吉西他滨 高危非肌层浸润性膀胱癌 血清胰岛素样生长因子结合蛋白-3 尿核基质蛋白22 复发率 

分 类 号：R737.14[医药卫生—肿瘤]