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[目的]探讨性激素及其受体在高发区食管鳞癌发生、分化、转移中的作用。[方法]采用放射免疫法(RIA)检测食管癌高发区林州原发性食管鳞癌患者44例和林州当地以及食管癌低发区同龄健康体检者各60人的血清性激素水平;采用免疫组化法(ABC)测定72例青年食管鳞癌患者(≤40岁)的手术切除标本ER表达状况。[结果]男性低发区健康人组、高发区健康人组和患者的血清雌激素水平分别为70.500±11.300pg/ml、54.684±18.159pg/ml、42.330±16.016pg/ml,女性低发区健康人组、高发区健康人组和患者的血清雌激素水平分别为87.010±13.910pg/ml、52.044±21.790pg/ml、32.998±19.339pg/ml,低发区健康人组的血清雌激素水平高于高发区健康人组和患者(男性的P值均为<0.001,女性的P值分别为0.0183和<0.001);男性低发区健康人组、高发区健康人组和患者的血清雄激素水平分别为4.100±1.500ng/ml、5.485±2.485ng/ml、5.555±2.648ng/ml,女性低发区健康人组、高发区健康人组和患者的血清雄激素水平分别为0.618±0.076ng/ml、1.795±0.959ng/ml、1.985±0.990ng/ml,低发区健康人组的血清雄激素水平低于高发区健康人组和患者(男性的P值分别为0.0457和<0.001,女性的P值均为<0.001)。高发区青年食管鳞癌患者中,高、中、低分化者的ER阳性率分别为65%、54%、37%(P=0.0684),淋巴结有无转移者ER阳性率分别为44%、58%(P=0.3450),侵及黏膜下层—肌层和纤维膜者的ER阳性率分别为42%、53%(P=0.5368),TNM分期处于Ⅰ、Ⅱ期和Ⅲ期ER阳性率分别为66%和35%(P=0.0176)。[结论]食管癌高发区人群血清雌激素水平过低和雄激素水平过高及其比例改变可能是决定食管癌变和易感性的重要因素之一。结合性激素受体状态检测可能更有助于加深对性激素与食管鳞癌关系的认识。
[Objective] To explore the role of sex hormones and their receptors in the occurrence, differentiation and metastasis of esophageal squamous cell carcinoma in high incidence areas. [Methods] Radioimmunoassay (RIA) was used to detect the levels of serum sex hormones in 44 cases of primary esophageal squamous cell carcinoma and 60 cases of local healthy esophageal cancer in Linzhou, Tissue method (ABC) was used to determine ER expression in surgical specimens from 72 patients with esophageal squamous cell carcinoma (≤ 40 years old). [Results] The levels of serum estrogen in the male low-risk group, high-risk group and the healthy people were 70.500 ± 11.300pg / ml, 54.684 ± 18.159pg / ml and 42.330 ± 16.016pg / ml, respectively. Serum estrogen levels of healthy people group, high risk group and patients were 87.010 ± 13.910pg / ml, 52.044 ± 21.790pg / ml and 32.998 ± 19.339pg / ml, respectively. Serum estrogen level (P <0.001 for males and 0.0183 for females and <0.001 for males). Serum androgen levels were significantly higher in healthy male subjects, high-risk healthy subjects and patients The levels of serum androgens in healthy female group and high-risk group were 4. 100 ± 1.500ng / ml, 5.485 ± 2.485ng / ml and 5.555 ± 2.648ng / ml, respectively. The levels of serum androgens were 0.618 ± 0.076ng / ml, 1.795 ± 0.959 ng / ml and 1.985 ± 0.990 ng / ml respectively, the level of serum androgen in healthy subjects is lower than that in healthy subjects and high risk patients (P = 0.0457 and <0.001, P <0.001). The ER positive rates of high, moderately and poorly differentiated esophageal squamous cell carcinoma patients were 65%, 54%, 37% (P = 0.0684), respectively. The positive rate of ER in lymph node metastasis was 44%, 58 % (P = 0.3450). The positive rates of ER in the submucosa-myometrium and fibrous membrane were 42% and 53% respectively (P = 0.5368). The positive rates of ER in ERKⅠ, Ⅱ and Ⅲ were 66% and 35% (P = 0.0176). [Conclusion] It is possible that serum estrogen level is too low and androgen level is too high and the proportion of estrogen is high in esophageal cancer-prone areas may be one of the important factors that determine esophageal carcinogenesis and susceptibility. Combined with hormone receptor status testing may be more helpful to deepen the understanding of sex hormone and esophageal squamous cell carcinoma.