脑胶质瘤MGMT基因表达及启动子甲基化与患者临床预后关系的观察．

目的 探讨O6-甲基鸟嘌呤-DNA甲基转移酶（MGMT）基因表达及启动子甲基化与脑胶质瘤患者临床预后的关系。方法 选取郑州大学人民医院神经外科2007年4月至2009年4月收治的同意接受脑胶质瘤个体化综合治疗且有完整病历资料的患者78例,根据脑胶质瘤MGMT基因表达及启动子甲基化情况分组,术后均采用同步放化疗,观察患者近期疗效、无进展生存时间及安全性,比较各组间疗效。两组间均数比较采用独立样本t检验,计数资料采用R×C表χ2检验,采用Kaplan-Meier方法绘制生存曲线,并采用Log-rank检验对其生存曲线进行分析。结果 MGMT基因启动子甲基化状态与MGMT蛋白表达呈负相关（r=-0.514,P〈0.05）。MGMT基因启动子甲基化组近期客观疗效明显优于MGMT基因启动子非甲基化组（χ2=47.890,P=0.000）;MGMT蛋白低表达组近期客观疗效明显优于MGMT蛋白高表达组（χ2=30.032,P=0.000）。MGMT基因启动子甲基化患者生存期明显长于非甲基化组（χ2=21.405,P〈0.05）,MGMT蛋白低表达患者生存期明显长于MGMT蛋白高表达组（χ2=18.643,P〈0.05）;MGMT基因启动子甲基化组客观有效率81.0%（34/42）优于MGMT蛋白低表达组74.4%（29/39）。患者均未出现明显不良反应。结论 脑胶质瘤MGMT基因表达及启动子甲基化与患者应用尼莫司汀＋替莫唑胺会师化疗同步适行放疗治疗预后密切相关,且MGMT甲基化对判断恶性胶质瘤患者预后吻合性更高,为临床制订有效的个体化疗方案提供参考。

Relationship between MGMT gene expression and promoter methylation and the clinical prognosis of patients with glioma

Objective To investigate the influence of O6-methylguanine-DNA methyltransferase （MGMT） gene promoter methylation and expression in malignant glioma tissues and the clinical prognosis observation of malignant glioma patients. Methods A total of 78 postoperative patients who agreed to glioma individualized comprehensive treatment with complete clinical data were collected, admitted to Department of Neurosurgery,People＇s Hospital of Zhengzhou University from April 2007 to April 2009, all patients were grouped by detecting the glioma MGMT gene promoter methylation and protein expression. All patients received radiotherapy combined with chemotherapy treatment postoperation. The efficacy of two groups by observing short-term curative efficacy, survival time and the safety through the long-term follow-up were compared. The two groups of mean differences were compared by independent t-test, chi-square test was applied to count data R x C table, and Kaplan-Meier method was used to draw survival curves, survival curve was analyzed by Log-rank test. Results The status of MGMT gene promoter methylation demonstrate a negative correlation with MGMT protein expression（ r = -0. 514 ,P 〈 0. 05 ）. The short-term curative efficacy in MGMT gene promoter methylation group was significantly superior to MGMT gene promoter unmethylation group（χ2 = 47. 890 ,P = 0. 000）, and the short-term curative efficacy of low MGMT protein expression group was significantly superior to the high expression group（x2 = 30. 032, P = 0. 000）. The survival time in MGMT gene promoter methylation group was significantly superior to the MGMT gene promoter unmethylation group （χ2 = 21. 405, P 〈 0. 05 ）. And the survival efficacy time of low MGMT protein expression group was significantly superior to the high expression group （χ2 = 18. 643 ,P 〈 0. 05 ）. The objective curative rate in MGMT gene promoter methylation group 81.0% （34/42）was superior to the low MGMT protein expression group 74. 4% （29/39）. No adverse reacti