CAJ | 학술논문

目的：分析不同临床病理特征的乳腺癌患者血浆D-二聚体（ D-D）水平的差异，探讨血浆D-D检测在乳腺癌病情监测及预后判断中的应用价值。方法选择资料保存完整的乳腺癌患者189例，其中接受外科手术治疗者129例，接受全身辅助治疗者60例。所有患者经治疗6～8个月后复诊时，完全缓解（CR）53例、部分缓解（PR）47例、疾病稳定（SD）48例、疾病进展（PD）41例。分别于治疗前、治疗后14 d、治疗后6～8个月复诊时，采用酶联免疫荧光法检测静脉血血浆D-D水平。比较不同年龄、乳腺癌病理类型、TNM分期、肿瘤大小、淋巴结转移、雌激素受体（ ER）表达、孕激素受体（ PR）表达、人类表皮生长因子受体-2（ HER-2）表达、手术治疗前后、全身辅助治疗前后及不同临床疗效（ CR、PR、SD、PD）患者的血浆D-D水平。结果 TNM分期Ⅲ、Ⅳ期者血浆D-D水平高于Ⅰ、Ⅱ期患者，肿瘤直径≥5 cm者血浆D-D水平高于肿瘤直径＜5 cm者，有淋巴结转移者血浆D-D水平高于未转移者，手术治疗后血浆D-D水平低于治疗前，全身辅助治疗后血浆D-D水平低于治疗前（ P均＜0．05）。临床疗效为CR、PR者治疗后血浆D-D水平低于治疗前，PD者治疗后血浆D-D水平高于治疗前（P均＜0．05），SD者治疗前后血浆D-D水平差异无统计学意义。结论血浆D-D水平与乳腺癌患者的TNM分期、肿瘤直径、淋巴结转移及预后有关，手术及全身辅助治疗可降低血浆D-D水平。
목적：분석불동림상병리특정적유선암환자혈장D-이취체（ D-D）수평적차이，탐토혈장D-D검측재유선암병정감측급예후판단중적응용개치。방법선택자료보존완정적유선암환자189례，기중접수외과수술치료자129례，접수전신보조치료자60례。소유환자경치료6～8개월후복진시，완전완해（CR）53례、부분완해（PR）47례、질병은정（SD）48례、질병진전（PD）41례。분별우치료전、치료후14 d、치료후6～8개월복진시，채용매련면역형광법검측정맥혈혈장D-D수평。비교불동년령、유선암병리류형、TNM분기、종류대소、림파결전이、자격소수체（ ER）표체、잉격소수체（ PR）표체、인류표피생장인자수체-2（ HER-2）표체、수술치료전후、전신보조치료전후급불동림상료효（ CR、PR、SD、PD）환자적혈장D-D수평。결과 TNM분기Ⅲ、Ⅳ기자혈장D-D수평고우Ⅰ、Ⅱ기환자，종류직경≥5 cm자혈장D-D수평고우종류직경＜5 cm자，유림파결전이자혈장D-D수평고우미전이자，수술치료후혈장D-D수평저우치료전，전신보조치료후혈장D-D수평저우치료전（ P균＜0．05）。림상료효위CR、PR자치료후혈장D-D수평저우치료전，PD자치료후혈장D-D수평고우치료전（P균＜0．05），SD자치료전후혈장D-D수평차이무통계학의의。결론혈장D-D수평여유선암환자적TNM분기、종류직경、림파결전이급예후유관，수술급전신보조치료가강저혈장D-D수평。
Objective To analyze the correlation between the serum level of D-D and clinicopathologic feature of breast cancer patients, to investigate the clinical value of D-D in therapeutic effect monitoring and prognosis judgement of breast cancer.Methods A total of 189 breast cancer patients were involved in this study, including 129 surgery patients and 60 systemic chemotherapy patients.After a recertification of 6 to 8 months later, the curative effects were collected as 53 cases of complete remission( CR) , 47 cases of partial remission( PR) , 48 cases of stable disease( SD) and 41 cases of progressive disease( PD) .The serum D-D level of all patients were detected by ELISA method at the time of treatment be-fore, 14 days after treatment and 6 to 8 months recertification.The correlation between the serum level of D-D and age, pathological type, TNM-stage, tumor size, lymph node metastasis, surgical treatment, systemic therapy, ER expression, PR expression, HER-2 expression, clinical prognosis of breast cancer were analyzed .Results The serum level of D-D inⅢ, Ⅳstage, tumor size≥5 cm, lymph node metastasis, surgery treatment, systemic chemotherapy were significant higher (P<0.05).The post treatment serum level of D-D in CR, PR patients were significant lower than treatment before (P<0.05).The post treatment serum level of D-D in PD patients were significant higher than treatment before (P<0.05). The serum level of D-D in SD patients showed no significant difference before and post treatment.Conclusions The serum level of D-D in breast cancer was positively correlated with the clinical pathologic characteristics such as TNM-stage, tumor size, lymph node metastasis and prognoses.The serum level of D-D level in breast cancer patients decreased after surgery and systemic treatment.