ROLE OF TNF AND IL-1 IN PATHOPHYSIOLOGY AND HOST-DEFENCE MECHANISM IN PATIETNTS WITH PROSTATE CANCER

本研究旨在探讨前列腺癌患者血清肿瘤坏死因子（TNF）与凝血功能障碍及恶病质的关系。采用酶免疫分析法测定了110例前列腺癌患者血清中TNF水平。76%的复发性疾病患者血清TNF活性为阳性，而未经治疗的患者和内分泌治疗缓解的患者中仅11%为阳性。血清TNF水平升高的患者血清纤维蛋白/纤维蛋白原降解产物E片段（FDP）和血浆纤维蛋白降解产物D-二聚体（D-dimer）、凝血酶-抗凝血酶-III复合物（达特）和纤溶酶-α 2-抗纤溶酶抑制剂复合物（PIC）水平均显著高于血清TNF水平未检出的患者。凝血障碍患者血清TNF水平显著升高。血清TNF水平升高的患者的血清总蛋白和白蛋白水平、血红蛋白水平、体重指数和体力状态均显著低于血清TNF水平检测不到的患者的相应值。血清TNF水平升高的患者的死亡率明显高于血清TNF水平检测不到的患者。恶病质患者血清TNF水平较无恶病质患者显著升高。提示TNF可能是前列腺癌患者凝血功能障碍及恶病质综合征的发病因素之一。

The present study was undertaken to evaluate the relationship between serum tumor necrosis factor (TNF) and coagulopathy and cachexia in patients with prostate cancer. TNF levels were determined in 110 serum samples from prostate cancer patients by an enzyme immunoassay. Serum TNF activity was positive in 76% of the patients with relapsed disease, whereas only 11% of the untreated patients and 0% of the patients in remission as a result of endocrine therapy were positive. Serum levels of fibrin/fibrinogen degradation product E fragment (FDP) and plasma levels of fibrin degradation product D-dimer (D-dimer), thrombin-antithrombin-III complex (TAT) and plasmin-a2-antiplasmin inhibitor complex (PIC) in patients with elevated serum TNF levels were significantly higher than those in patients with undetectable serum TNF levels. Patients with coagulopathy had a significant increase in serum TNF levels. The serum total protein and albumin levels, hemoglobin levels, and body mass index and performance status of the patients with elevated serum TNF levels were significantly impaired than the corresponding values in patients with undetectable serum TNF levels. Patients with elevated serum TNF levels had a significantly higher mortality rate than those with undetectable serum TNF levels. Patients with cachexia showed a significant increase in serum TNF levels than patients without cachexia. These findings suggest that TNF may be one of the factors contributing to the coagulopathy and complex syndrome of cachexia in patients with prostate cancer.