膀胱肿瘤抗原和透明质酸等七项肿瘤标志物在膀胱肿瘤诊断中的应用价值  

Clinical evaluation of BTAstat,NMP22,HA,survivin,CD44v6,VEGF and VUC in bladder cancer diagnosis

作　　者：孙羿[1] 何辉[1] 马强[1] 王新阳[1] 杨林[1] 贺大林[1] 

机构地区：[1]西安交通大学泌尿外科研究所西安交通大学医学院第一附属医院泌尿外科,710061

出　　处：《中华医学杂志》2005年第35期2507-2512,共6页National Medical Journal of China

基　　金：卫生部临床学科重点资助项目(20012029)

摘　　要：目的评价膀胱肿瘤抗原(BTAstat)、核基质蛋白22(NMP22)、透明质酸(HA)、生存蛋白、CD44v6、血管内皮生长因子(VEGF)和VUC7项指标在膀胱肿瘤诊断中的应用价值。方法检测52例膀胱肿瘤患者,11例良性泌尿系疾病患者,10例正常人的清洁中段晨尿中各指标,计算各指标及两两指标联合的敏感度与特异度、变异系数、检测耗时、费用,评价其应用价值。结果各指标在肿瘤组与对照组间均有显著性差异。敏感度和特异度分别为:VUC(42·3%,100%);BTAstat(78·8%,90·5%);NMP22(76·9%,81·0%);HA(86·5%,90·5%);生存蛋白(67·3%,85·7%);CD44v6(50·0%,85·7%);VEGF(69·2%,95·2%)。联合指标敏感度最高的是NMP22+HA和HA+CD44v6(96·2%),最低的是VUC+CD44v6(67·3%)。特异度最高的是VUC+NMP22和VUC+VEGF(95·2%),最低的是HA+生存蛋白(66·7%)。BTAstat检测操作最简便,HA检测费用最低。BTAstat、VUC可重复性最高。结论各指标在膀胱肿瘤的诊断中均有应用价值。除CD44v6外,随着分期分级的升高各指标诊断敏感度增加。综合敏感度、特异度、检测的可重复性及检查操作的难易和费用,BTAstat+HA是最佳组合。Objective To evaluate the sensitivity and specificity of BTAstat, NMP22, HA, Survivin, CD44v6, VEGF, and VUC in detection of bladder cancer. Methods We detect VUC, BTAstat, NMP22, HA, Survivin, CD44v6, VEGF in the urine of 10 normal case （healthy volunteers）, 11 benign urological diseases patients and 52 bladder cancer patients. The sensitivity, specificity the coefficient of variation, the examining time duration and the checking costs of each marker and combined markers were assessed to evaluate the clinical value, Results There is a significant difference between the cancer group and the two control groups. The overall sensitivity and specificity of urinary tumor markers were： 42. 3% and 100% for VUC; 78.8% and 90.5% for BTAstat; 76.9% and 81.0% for NMP22; 86. 5% and 90. 5% for HA; 67.3% and 85.7% for Survivin; 50. 5% and 85.7% for CD44 and 69. 2% and 95.2% for VEGF. The highest sensitivity of combined markers was 96. 2% for NMP22 ＋ HA and HA ＋ CD44v6, whereas the lowest sensitivity of combined markers was 67.3% for VUC ＋ CD44v6. The highest specificity （95.2%） was the combined use of VUC ＋ NMP22 and combined use of VUC ＋ VEGF, whereas, method that achieved the lowest specificity （66.7%） was the combined use of HA ＋ Survivin. The most convenient examining method was the detection for BTAstat; the lowest cost examining method was the detection for HA; methods which had the best repeatability were the detection for BTAstat and urine cytology examination. Conclusion Each marker had achieved its obvious clinical value in diagnosis of bladder cancer. The sensitivity of all the markers was increased with the progression of tumor grades and clinical stages, except the CD44v6. The combined use of BATstat and HA is the best examining method concerning sensitivity, specificity, feasibility and cost in each different method.

关 键 词：膀胱肿瘤 肿瘤标志物 尿液 诊断 膀胱肿瘤抗原 肿瘤诊断 透明质酸 血管内皮生长因子(VEGF) 价值 BTAstat 

分 类 号：R737.14[医药卫生—肿瘤] R730.4[医药卫生—临床医学]