摘要目的 探讨结直肠癌组织中多不饱和脂肪酸(PUFA)的含量与临床病理因素的关系,评价PUFA的含量在结直肠癌预后判断中的价值.方法 新鲜冰冻的肿瘤组织取自2010年12月至2011年3月解放军总医院普通外科行结直肠癌切除术的82例患者,其中男51例、女31例；年龄29 ～ 83岁,中位年龄60.2岁.应用气相色谱毛细管层析法检测标本中各PUFA的含量并进行常规病理检查及免疫组织化学检测.按各脂肪酸成分及相关脂肪酸比值,分别从性别、年龄、肿瘤发生位置、病理特征、转移情况及患者血管内皮生长因子(VEGF)、Ki-67及P53肿瘤指标不同表达程度等方面比较组织中各PUFA含量差异.采用t检验、方差分析检验比较不同临床病理情况下的各PUFA含量差异.结果 年龄≥60岁患者(n=44)中花生四烯酸(AA)含量低于年龄＜60岁患者(n=38)(0.12％±0.06％比0.17％±0.09％,P=0.045).肿瘤大小＜5 cm(n=42)的组织中二十碳五烯酸(EPA)含量高于肿瘤≥5 cm者(n=40)(0.29％±0.13％比0.20％±0.14％,P =0.030),而ω-6/ω-3PUFA则低(10.8±2.6比13.2 ±6.4,P =0.031).分化程度不同的患者肿瘤组织中亚油酸含量和AA/ω-3 PUFA差异均有统计学意义(P =0.013、0.027),分化程度低者亚油酸含量最高(19.9％±6.3％)而AA/ω-3 PUFA最低(4.1±2.0).在VEGF阳性肿瘤患者组织中亚油酸含量高于阴性者(16.2％±3.7％比13.9％±2.7％,P=0.009),而AA/ω-3 PUFA、AA/ω-6 PUFA、AA/亚油酸均低(5.0±1.8比6.7±3.3,0.30±0.09比0.34±0.09,0.50 ±0.21比0.61 ±0.21,P=0.004、0.038、0.030).在Ki.-67不同表达程度的患者肿瘤组织中亚油酸含量差异有统计学意义(P =0.048),Ki-67阴性者亚油酸含量最高(22.5％±10.1％).各脂肪酸含量在性别、临床分期、淋巴结转移及P53指标中差异均无统计学意义(均P＞0.05).结论 肿瘤组织中PUFA的含量与临床病理指标有关联,并在一定程度上可以反映出肿瘤的恶性程度及预后等情况.

abstractsObjective To explore the relationship between different tissue levels of polyunsaturated fatty acid (PUFA) and the clinicopathologic parameters in colorectal carcinoma (CRC) and evaluate their prognostic significance.Methods Fresh frozen malignant tissue was obtained from 82 colorectal cancer patients at PLA general Hospital from December 2010 to March 2011.The immunohistochemical results were obtained for vascular cndothelial growth factor(VEGF),P53 and Ki-67.The relationship between the PUFA level and such clinicopathological profiles as age,gender,location,differentiation degree,TNM (tumor,node and metastasis) stage,VEGF,Ki-67 and P53 was analyzed.Results Tissue level of arachidonic acid (AA) in patients aged over 60 years (n =44) was significantly lower than those under 60 years (n =38) (0.12％±0.06％ vs 0.17％±0.09％,P =0.045).In patients with tumor size ＜ 5 cm (n =42),tissue level of EPA was significantly higher (0.29％ ± 0.13％ vs 0.20％ ± 0.14％,P =0.030) while ω-6/ω-3 PUFA lower (10.8 ± 2.6 vs 13.2 ± 6.4,P =0.031).Significant statistical difference existed in tissue level of LA,AA/ω-3 PUFA in different differentiation degrees(P =0.013,0.027).Tissue level of linoleic acid (LA) in poorly differentiated tumor was the highest (19.9％ ± 6.3％) while AA/ω-3 PUFA the lowest (4.1± 2.0,P ＜ 0.05).Tissue level of LA was higher in VEGF-positive tumors than those in VEGF-negative counterparts (16.2％ ± 3.7％ vs 13.9％ ± 2.7％,P =0.009) while the ratios AA/ω-3 PUFA,AA/ω-6 PUFA,AA/LA in VEGF-positive tumors were lower than those in VEGF-negative counterparts (5.0±1.8 vs 6.7±3.3,0.30±0.09 vs 0.34±0.09,0.50±0.21 vs0.61±0.21,P=0.004,0.038,0.030).In Ki-67 negative LA was highest (22.5％ ± 10.1％,P =0.048).No significant differences existed in the level of PUFA among the gender,the clinicopathological stage,lymph node metastasis and groups with differential expressions of P53 (all P ＞ 0.05).Conclusions The tissue levels of PUFA are somewhat correlated with the clinicopathologic parameters of CRC.And the prognosis of CRC may be evaluated through the test of PUFA.