The Study on Calcitonin and Calcitonin Gene-Related Peptide in Patients with Medullary Thyroid Carcinoma
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摘要: 目的:探讨甲状腺髓样癌患者降钙素及其基因相关肽的变化规律以指导临床治疗方案的选择和患者预后的判断。方法:对58例甲状腺髓样癌患者血清中降钙素进行分析及应用免疫组织化学方法观察相应标本中降钙素及其基因相关肽的表达情况;对新入组患者进行放射免疫学测定。结果:1)术前降钙素水平正常与升高的患者之间,颈淋巴结转移存在显著性差异(P<0.01)。2)术后1个月降钙素水平正常与升高的患者之间,肿瘤复发存在显著性差异(P<0.01)。3)约98%的患者肿瘤标本降钙素染色呈阳性,而降钙素基因相关肽的阳性率为87.8%。4)部分术前降钙素水平正常的患者降钙素基因相关肽水平升高。5)术后1周左右降钙素下降至一稳定水平。结论:降钙素可以作为指导甲状腺髓样癌诊断和治疗的重要指标,检测降钙素基因相关肽有助于部分降钙素阴性的甲状腺髓样癌患者术前诊断。Abstract: Objective : In order to offer the basis for the treatment and prognosis in patients with medullary thyroid carcinoma (MTC), the CT and calcitonin gene-related peptide (CGRP) were investi-gated. Methods : Fifty-eight cases of MTC were selected and the relationship between the CT levels and metastasis was investigated. Immunohistochemical method was used to detect the expression of CT and CGRP in 58 samples of MTC tissues. The CT and CGRP of new MTC inpatients were measured before operation and in the first few days after operation using radioimmunoassy. Results : 1) The metastatic rate of cervical lymph node had significant difference between the normal plasma CT group and elevated group (P<0.01). 2) The rate of tumoral residue had significant difference between the normal plasma CT group one month after operation and the elevated group in the same period (P<0.01). 3)In the immunohistochemical study we found that the positive rate of CT was about 98%, and the CGRP was 87.8%. 4) Part of the patients had the elevated CGRP levels, whose CT levels was normal. 5) The plasma CT levels dropped to with the stable range one week after operation. Conclusions : The CT levels are useful index to evaluate the cervical lymph node metastasis and the efficacy of surgical treatment. The plasma CGRP measurement is a way for the diagnosis of MTC especially for those patients whose preoperative CT levels are normal.
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