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目的 :通过检测直肠癌术前放疗患者放疗前后凋亡、增殖指数以及凋亡调控基因表达的变化 ,探讨直肠癌自发性凋亡及放射性凋亡的可能调控机制。方法 :分析 2 3例接受术前放疗的直肠癌患者的临床资料。采用TUNEL法观察放疗前活检标本及放疗后手术切除标本的细胞凋亡情况。免疫组化方法检测所取标本的p5 3、p2 1、PCNA、bcl 2、bax等表达情况。结果 :放疗前活检标本中凋亡指数为 2 8± 1 4,而放疗后标本中凋亡指数为 4 9± 1 3 ,P <0 0 1。放疗后p5 3、p2 1、bcl 2、PCNA染色阳性率较放疗前均下降 ,而bax表达阳性率由放疗前的 3 4 8%上升到放疗后的 65 2 % ,但差异均无统计学意义 ,P >0 0 5。在放疗前活检标本中 ,p5 3 ( -)p2 1( +)组的凋亡指数为 4 2± 1 0 ,高于p5 3 ( +)p2 1( -)组的 2 3± 0 6,P <0 0 5。放疗后手术标本中 ,p5 3 ( -)p2 1( +)组的凋亡指数为 5 8± 1 5 ,高于p5 3 ( +)p2 1( -)组的 4 3±0 6,P <0 0 5。结论 :在直肠癌组织的自发凋亡和放射性凋亡过程中 ,p5 3 /p2 1途径均起到了关键作用 ,bax也可能起到一定的作用。
Objective: To investigate the possible regulatory mechanism of spontaneous apoptosis and apoptosis in rectal cancer by detecting the changes of apoptosis, proliferation index and expression of apoptosis-controlling genes in patients with rectal cancer before and after radiotherapy. Methods: Clinical data of 23 patients with rectal cancer undergoing preoperative radiotherapy were analyzed. TUNEL method was used to observe the apoptosis of the biopsy specimens before radiotherapy and the resected specimens after radiotherapy. Immunohistochemistry was used to detect the expression of p5 3, p2 1, PCNA, bcl 2 and bax. Results: The apoptotic index in biopsy specimens before radiotherapy was 28 ± 14, and the apoptotic index in radiotherapy specimens was 49 ± 1 3 (P <0.01). The positive rate of p5 3, p2 1, bcl 2 and PCNA after radiotherapy was lower than that before radiotherapy, while the positive rate of bax expression increased from 34 48% before radiotherapy to 65 2% after radiotherapy, but the difference was not statistically significant , P> 0 0 5. In the biopsy specimens before radiotherapy, the apoptotic index of p5 3 (-) p2 1 (+) group was 42 ± 10, which was higher than that of p5 3 (+) p2 1 (- <0 0 5. The apoptotic index of p5 3 (-) p2 1 (+) group was 58 ± 1 5, which was higher than that of p5 3 (+) p2 1 (-) group (P < 0 0 5. CONCLUSION: The p5 3 / p2 1 pathway plays a key role in the spontaneous apoptosis and radiation apoptosis of rectal cancer, and bax may play a role.