交通医学

目的：探讨乳腺癌组织及血清中三叶因子1(trefoil factor 1,TFF-1)的表达特征及其临床价值。方法：纳入80例乳腺癌患者及20例良性乳腺病变患者为研究对象，采用免疫组织化学检测组织中TFF-1蛋白表达，酶联免疫吸附试验检测血清TFF-1水平。结果：乳腺癌组织TFF-1阳性率77.5%，显著高于癌旁组织的35.0%(P<0.001)。血清TFF-1表达水平Ⅲ期患者高于Ⅰ/Ⅱ期患者[（1.882±0.221）ng/mL vs(1.124±0.552)ng/mL]，组织学分级3级患者高于1～2级患者[（1.890±0.524）ng/mL vs(1.151±0.423)ng/mL]，淋巴结转移患者高于无淋巴结转移患者[（1.853±0.212）ng/mL vs(1.170±0.624)ng/mL]，有脉管侵犯患者高于无脉管侵犯患者[（1.793±0.263）ng/mL vs(1.211±0.520)ng/mL]（均P<0.001）。乳腺癌患者血清TFF-1水平（1.671±0.852）ng/mL，高于良性乳腺病变患者的（0.822±0.781）ng/mL(t=5.528,P=0.006)。乳腺癌4种分子分型间血清TFF-1水平差异有统计学意义（F=14.41,P<0.001）；三阴性乳腺癌患者血清TFF-1水平（1.861±0.220）ng/mL，高于其他3型患者，Her-2过表达型患者血清TFF-1水平（1.661±0.362）ng/mL高于Luminal A型的（1.242±0.363）ng/mL和Luminal B型的（1.521±0.280）ng/mL（均P<0.05）。乳腺癌4种分子分型间癌组织TFF-1蛋白表达比较，差异有统计学意义（H=32.17,P<0.001）；三阴性乳腺癌及HER-2过表达型乳腺癌组织中TFF-1蛋白表达水平明显高于Luminal A型患者、Luminal B型患者（均P<0.05）。结论：TFF-1在乳腺癌组织及血清中高表达，其表达水平可能与肿瘤的组织学分级、淋巴结转移、TNM分期、脉管侵犯等不良病理特征相关，提示TFF-1可能作为乳腺癌诊断及预后评估的潜在标志物。

Objective: To explore the expression characteristics of trefoil factor 1(TFF-1) in both breast cancer tissues and serum, and its clinical value. Methods: A total of 80 breast cancer patients and 20 patients with benign breast diseases were enrolled. The expression of TFF-1 protein in tissues was detected by immunohistochemistry method, and serum level of TFF-1 was tested by enzyme-linked immunosorbent assay(ELISA) method. Results: In breast cancer tissues,the positive rate of TFF-1 was 77.5%, which was significantly higher than 35.0% in adjacent tissues. Serum TFF-1 levels in stage III patients were(1.882±0.221) ng/mL, which were higher than those in stage I/II patients(1.124±0.552) ng/mL. Serum TFF-1 levels in histological grade 3 patients were(1.890±0.524) ng/mL, which were higher than those in grade1～2 patients(1.151±0.423) ng/mL. Serum TFF-1 levels in patients with lymph node metastasis were(1.853±0.212) ng/mL,which were higher than those in patients without lymph node metastasis(1.170±0.624) ng/mL. Its levels in patients with vascular invasion were(1.793±0.263) ng/mL, which were higher than those without vascular invasion(1.211±0.520) ng/mL(P<0.001). Serum TFF-1 levels in breast cancer patients were(1.671±0.852) ng/mL, which were higher than those in patients with benign breast lesions(0.822±0.781) ng/mL(t=5.528, P=0.006). There was a statistical difference in serum TFF-1 levels among the four molecular subtypes of breast cancer(F=14.41, P<0.001). Serum TFF-1 levels in triple-negative breast cancer patients were(1.861±0.220) ng/mL, which were higher than those in the other three subtypes. Serum TFF-1 levels in Her-2 overexpression subtype patients were(1.661±0.362) ng/mL, which were higher than those in Luminal A(1.242±0.363) ng/mL and Luminal B subtypes patients(1.521±0.280) ng/mL(P<0.05). There was also a statistical difference in TFF-1 protein expression in cancer tissues among the four molecular subtypes(H=32.17, P<0.001). TFF-1 expression in triple-negative breast cancer and HER-2 overexpression subtypes was significantly higher than that in Luminal A and Luminal B subtypes(P < 0.05). Conclusion : TFF-1 is highly expressed in both breast cancer tissues and serum. Its expression level may be associated with adverse pathological features such as histological grading of tumors, lymph node metastasis, TNM stage and vascular invasion, suggesting that TFF-1 may serve as a potential biomarker for the diagnosis and prognostic assessment of breast cancer.