内镜黏膜下剥离术在结直肠侧向发育型肿瘤患者中的治疗效果及对Wnt和整合素信号通路的影响*

Clinical effect of endoscopic submucosal dissection in patients with colorectal metastatic tumors and its impact on Wnt and integrin signaling pathways*

摘要:

探究内镜黏膜下剥离术（ESD）在结直肠侧向发育型肿瘤（LST）患者中的治疗效果及对Wnt和整合素信号通路的影响。方法 选取2016年1月－2018年6月该院收治的70例结直肠LST患者，随机分为两组，给予对照组患者分片切除术，研究组患者采用ESD。观察对比两组患者的诊治情况和术后不良反应情况，同时观察比较两组患者手术前后生活质量水平和免疫功能情况，并分析手术对Wnt及整合素信号通路的影响。结果 两组患者诊治的病变位置、直径大小及大体分型差异无统计学意义（P >0.05）；两组患者在术后均未出现严重并发症，如穿孔、消化道出血，研究组患者术后复发率为2.9%，对照组患者术后复发率为8.6%，研究组复发率与对照组无明显差异（P >0.05）；术前两组患者的生命质量评分（QOL）差异无统计学意义（P >0.05），术后研究组与对照组患者QOL评分明显低于术前，差异有统计学意义（P <0.05），且术后研究组患者QOL评分明显低于对照组，差异有统计学意义（P <0.05）；治疗前，两组Wnt/β-catenin通路分子表达量没有明显区别（P >0.05），治疗后，研究组Wnt1、Wnt5a、Wnt7b和β-catenin指标均明显低于对照组（P <0.05）。结论 ESD在结直肠LST患者的治疗中具有良好的临床疗效，可提高患者术后的生活质量水平和免疫功能。在手术的刺激下，会迅速抑制Wnt与其他受体复合物结合，使Wnt的靶基因得不到表达，有利于整合素信号通路。ESD在结直肠LST患者中可以有效抑制Wnt基因的表达，阻断Wnt在肿瘤的发生、发展及转移，具有广泛的应用前景，值得在临床上进一步推广和应用。

Abstract:

To explore the clinical effect of endoscopic submucosal dissection in patients with colorectal metastatic tumor and its impact on Wnt and integrin signaling pathways. Methods 70 patients with colorectal metastatic tumors from January 2016 to June 2018 were randomly divided into two groups. Patients in the control group were treated with submucosal dissection. Patients in the study group were treated with endoscopic submucosal dissection. Then observe and compare the pathological conditions of the two groups of patients, as well as the postoperative adverse reactions, and observe the quality of life and immune function before and after surgery, and analyze the impact of surgery on the Wnt and integrin signal pathways. Results There was no significant difference in lesion location, diameter and general classification between the two groups (P > 0.05). Serious complications occurred in both groups after surgery, such as perforation and gastrointestinal bleeding. The recurrence rate was 2.9% in the study group and 8.6% in the control group. There was no significant difference in the recurrence rate between the two groups. (P > 0.05). There was no statistically significant difference in the quality of life between the two groups before surgery (P > 0.05), and the QOL score of the patients in the study group and the control group was significantly lower than that before surgery (P < 0.05), and the QOL score of the patients in the study group was significantly lower than that of the control group after surgery (P < 0.05). Before treatment, there was no significant difference in the expression of Wnt/β-catenin pathway between the two groups (P > 0.05). After treatment, the Wnt1, Wnt5a, Wnt7b and β-catenin indexes in the study group were lower than those in the control group (P < 0.05). Conclusion Endoscopic submucosal dissection surgery in treatment of patients with colorectal lateral growth type of tumor has a good clinical curative effect, can improve the life quality of patients with postoperative level and immune function. Under the stimulation of surgery, the binding of Wnt to other receptor complexes is rapidly inhibited, so that the target gene of Wnt cannot be expressed, contributing to the integrin signaling pathway. It can effectively restrain Wnt gene expression, blocking Wnt in tumor occurrence, development and metastasis, has wide application prospect, is worth further promotion and application in clinic.