目的：探讨XIAP、SMAC在胆管癌组织中表达与两者在胆管癌患者血清中水平以及两者的临床意义。方法：用免疫组化方法检测54例胆管癌患者在胆管癌组织及其癌旁组织中XIAP与SMAC的表达，用ELISA法检测25例胆管癌患者与15例健康人血清中XIAP与SMAC的水平。分析两者表达与患者临床病理因素的关系，以及患者手术前后两者水平的变化。结果：胆管癌组织中XIAP表达阳性率明显高于癌旁组织（81.45% vs. 30.00%，P<0.05），而SMAC表达阳性率明显低于癌旁组织（38.89% vs. 80.00%，P<0.05）。XIAP表达与胆管癌病理分型及是否伴有淋巴结转移有关，而SMAC表达与胆管癌TNM分期、是否伴有淋巴结转移有关（均P<0.05）；在胆管癌组织中XIAP、SMAC表达呈负相关（r=-0.327，P<0.05）。胆管癌患者术前血清XIAP水平明显高于健康对照人群，而血清SMAC水平明显低于健康对照人群（均P<0.05）；术后两者水平术后趋向正常。XIAP与SMAC在胆管癌患者癌组织中的表达与其在血清中的水平具有一致性（r=0.381，P=0.025；r=0.623，P=0.000）。结论：胆管癌组织中XIAP表达升高，而SMAC表达降低；两者联合检测对胆管癌早期诊断、治疗效果及预后的判断有一定意义。
Changes in XIAP and SMAC levels in tumor tissue and serum of patients with cholangiocarcinoma and their clinical significance
Objective: To investigate the expressions of XIAP and SMAC in cholangiocarcinoma tissues and their serum levels in cholangiocarcinoma patients and then to analyze their clinical significance. Methods: The expressions of XIAP and SMAC in cholangiocarcinoma tissues together with the tumor adjacent tissues from 54 cholangiocarcinoma patients were detected by immuneohistochemical staining, and the serum levels of XIAP and SMAC in 25 cholangiocarcinoma patients and 15 healthy subjects were determined by ELISA assay. The relations of their expressions with clincopathologic factors of the patients and the changes in their serum levels in the patients before and after operation were analyzed. Results: In cholangiocarcinoma tissues compared with their adjacent tissues, the positive expression rate of XIAP was significantly increased (81.45% vs. 30.00%, P<0.05), while the positive expression rate of SMAC was significantly decreased (38.89% vs. 80.00%, P<0.05). The XIAP expression was significantly related to the pathological classification and presence or absence of lymph node metastasis, while SMAC expression was significantly related to the TNM stage and presence or absence of lymph node metastasis (all P<0.05), and there was a negative correlation between XIAP and SMAC expression in cholangiocarcinoma tissue (r=-0.327, P<0.05). In cholangiocarcinoma patients, the preoperative serum XIAP level was significantly higher and SMAC level was significantly lower than those in healthy control subjects (both P<0.05), and both of them tended to be normal after operation. The expressions of XIAP and SMAC in cholangiocarcinoma tissue and their serum levels in these patients had significant consistency (r=0.381, P=0.025; r=0.623, P=0.000). Conclusion: XIAP expression is increased and SMAC expression is decreased in cholangiocarcinoma, and their combined detection may have certain significance for early diagnosis and estimation of therapeutic effect and prognosis of cholangiocarcinoma.