Hammer J H, Basse L, Svendsen M N, Werther K, Brünner N, Christensen I J, Nielson H J
Department of Surgical Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark.
Colorectal Dis. 2006 Mar;8(3):168-72. doi: 10.1111/j.1463-1318.2005.00831.x.
Pre- and post-operative plasma tissue inhibitor of metalloproteinases-1 (TIMP-1) levels have a prognostic impact on patients with colorectal cancer. However, the surgical trauma may play an essential role in regulation of plasma TIMP-1 levels, which in turn may influence subsequent TIMP-1 measurements.
Consecutively, 48 patients with colon cancer (CC) and 12 patients with nonmalignant colonic disease were randomised to undergo elective laparoscopically assisted or open resection followed by fast track recovery. Plasma samples were collected just before and 1, 2 and 6 h after skin incision, and 1, 2, 8 and 30 days after surgery. TIMP-1 was determined concurrently in all samples by a validated ELISA method.
Geometric mean preoperative TIMP-1 level was 142 ng/ml (range 54-559 ng/ml) among CC patients compared with 106 ng/ml (range 64-167 ng/ml) among patients with nonmalignant diseases (P<0.0001). TIMP-1 levels were decreased significantly 2 h after skin incision compared to the preoperative levels returning to preoperative levels at 6 h. A highly significant (P<0.0001) maximum level was observed 1 day after surgery and was decreasing to preoperative levels 30 days after surgery. Patients undergoing laparoscopically assisted or open resection had similar TIMP-1 levels at each time point.
Major surgery has considerable impact on plasma TIMP-1 levels. Intra- and post-operative changes of plasma TIMP-1 levels are independent of the surgical approach, and resection for CC does not lead to a significant decrease of plasma TIMP-1 levels within 30 days postoperatively.
术前和术后血浆金属蛋白酶组织抑制因子-1（TIMP-1）水平对结直肠癌患者具有预后影响。然而，手术创伤可能在血浆TIMP-1水平的调节中起重要作用，而这反过来又可能影响随后的TIMP-1测量结果。
连续纳入48例结肠癌（CC）患者和12例非恶性结肠疾病患者，随机接受择期腹腔镜辅助或开放切除术，随后进行快速康复。在皮肤切开前、切开后1、2和6小时以及术后1、2、8和30天采集血浆样本。通过经过验证的酶联免疫吸附测定（ELISA）方法同时测定所有样本中的TIMP-1。
CC患者术前TIMP-1水平的几何平均值为142 ng/ml（范围54 - 559 ng/ml），而非恶性疾病患者为106 ng/ml（范围64 - 167 ng/ml）（P<0.0001）。与术前水平相比，皮肤切开后2小时TIMP-1水平显著降低，6小时恢复到术前水平。术后1天观察到一个高度显著（P<0.0001）的最高水平，术后30天降至术前水平。接受腹腔镜辅助或开放切除术的患者在每个时间点的TIMP-1水平相似。
大手术对血浆TIMP-1水平有相当大的影响。血浆TIMP-1水平的术中及术后变化与手术方式无关，CC切除术后30天内血浆TIMP-1水平不会显著降低。
