p53基因治疗对鼻咽癌患者 CD34标记的微血管密度和血小板计数的影响

目的：观察放化疗联合重组人p53腺病毒注射液（ rAd-p53）治疗鼻咽癌后对原发灶中CD34标记的微血管密度（ CD34-MVD）及血小板（ PLT）计数的影响，探讨其与预后的关系。方法63例中晚期鼻咽癌患者随机分为两组，基因组32例给予rAd-p53瘤内注射＋同步放化疗；常规组31例仅给予同步放化疗。采用免疫组化二步法检测两组患者癌组织中CD34-MVD水平，并检测PLT。结果治疗后基因组鼻咽癌原发灶CD34-MVD明显低于治疗前（ P＜0．05），而常规组治疗前后CD34-MVD比较差异无统计学意义（ P＞0．05）；治疗后两组PLT均显著下降（P均＜0．05），并且基因组下降更明显（P＜0．05）。随访3年，基因组和常规组局部复发、远处转移率比较差异无统计学意义（ P＞0．05）；但CD34-MVD表达增加组远处转移率（38．5％）明显高于表达下降组（13．5％）（P＜0．05），3年总生存率、无瘤生存率低于表达下降组（P＜0．05）；PLT增加组与PLT下降组的局部复发率、远处转移率、3年总生存率、无瘤生存率差异均无统计学意义（P均＞0．05）。结论放化疗联合基因治疗中晚期鼻咽癌，可使CD34-MVD、PLT计数明显下降。 CD34-MVD过度表达可作为评估远处转移和预后不良的参考指标。

Effect of p53 Gene Therapy on Microvessel Density Determined by CD34 and Platelet Count in Patients with Nasopharyngeal Carcinoma

Objective To observe the effect of chemo-radiotherapy combined with recombinant human p 53 adenovirus（rAd-p53） on microvessel density（MVD） determined by CD34 and platelet（PLT） count in patients with nasopharyngeal carcinoma ,and to investigate its relationship with the prognosis .Methods Sixty-three patients with advanced nasopharyngeal carcinoma were randomly divided into two groups , the gene group （ 32 cases ） recieved rAd-p53 intratumoral injection and concurrent chemo-radiotherapy , the control group （ 31 cases ） recieved concurrent chemo-radiotherapy .The two-step immunohistochemical method was used to detect MVD ,which was marked by CD 34 in the primary tumor tissues of nasopharyngeal carcinoma in two groups ,and PLT was also detected.Results CD34-MVD of primary tumor tissues of nasopharyngeal carcinoma after treatment was significantly lower than that before treatment in the gene group（P〈0.05）,there was no significant difference in CD34-MVD before and after treatment in the control group （P〉0.05）.PLT significantly decreased after treatment in the two groups （all P〈0.05）,and the decrease in the gene group was more significant（P〈0.05）.The follow-up lasted for three years,there was no significant difference in the local recurrence and distant metastasis rates between experimental group and control group （ P〉0.05）;The distant metastasis rate in the increasing CD34-MVD group was significantly higher than that in the decreasing CD34-MVD group （38.5% vs.＆amp;nbsp;13.5%,P〈0.05）,the 3-year overall survival ,disease-free survival in the increasing CD34-MVD group was lower than those in the decreasing CD34-MVD group（P〈0.05）;There was no significant difference in the local recurrence and distant metastasis rates ,3-year overall survival ,disease-free survival between increasing PLT group and decreasing PLT group （P〉0.05）.Conclusion CD34-MVD and PLT count decrease significantly after chemo-radiotherapy plus p53 gene therapy performed in patients with nasopharyngeal carcinoma .The over-expression of CD34-MVD could be a predictor of distant metastasis and poor prognosis of nasopharyngeal carcinoma .