免疫细胞化学标记在积液细胞学鉴别诊断中的应用  

The application of immunocytochemistry markers in cytological differential diagnosis of effusion smear

作　　者：袁勤[1] 叶廷军[1] 樊绮诗[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院检验科,上海200025

出　　处：《检验医学》2007年第1期50-53,共4页Laboratory Medicine

摘　　要：目的探讨免疫细胞化学特异性标记非肿瘤性增生的间皮细胞、转移性腺癌及恶性间皮瘤细胞在积液细胞学鉴别诊断中的意义。方法浆膜腔积液标本170例,苏木素-伊红(HE)染色,镜检细胞学形态,免疫细胞化学标记一系列单克隆抗体:癌胚抗原(CEA)、上皮细胞膜抗原(EMA)、细胞角蛋白(CK)、上皮相关抗原(MOC-31)、上皮细胞钙粘蛋白E、波形蛋白(VIM)和结蛋白。酶染色采用生物素化酶二步法。采用双盲法阅读免疫细胞化学染色结果。结果上述几种抗体在反应性增生的间皮细胞、癌和恶性间皮瘤3组标本中表达差异有统计学意义(P<0.01)。其中癌症组的CEA、EMA、MOC-31、钙粘蛋白E和CK阳性表达率分别为88%、97%、89%、92%和94%,而VIM和结蛋白呈现低表达,阳性表达率分别为6%和11%。良性间皮细胞标本组中,VIM和结蛋白阳性表达率分别为84%和91%,而CEA、EMA、MOC-31、钙粘蛋白E显示低表达,阳性表达率分别为13%、16%、9%和6%。恶性间皮瘤标本组中,CK、VIM、结蛋白呈现强阳性表达,阳性率为100%,而CEA、EMA、MOC-31、钙粘蛋白E表达呈阴性。结论选择一组特异性免疫细胞化学标记,可帮助传统的细胞形态学检查,对良、恶性浆膜腔积液的鉴别诊断起重要作用。Objective To evaluate the significance of immunocytochemistry markers of reactive methothelium （RM）, adenocarcioma （AC） and malignant mesothelioma （MM） in cytological differential diagnosis of effusion smear. Methods A total of 170 specimens of effusion were first evaluated by the traditional microscopy with hematoxylin-eosin, and then stained by a panel of immunocytochemistry markers including carcinoembryonic antigen （ CEA）, epithelial membrane antigen （ EMA ）, epithelial-related antigen （ MOC-31 ）, E-cadherin, cytokeratin （ CK ）, vimentin （ VIM ） and desmin. The immunoreaction results were evaluated independendy by two senior cytopathologists and were analysed by double-blind method. Results Statistical significance was found in the expression differentiation among the three groups mentioned above, comparing the groups of RM, AC and MM （ P 〈 0.01 ）. CEA, EMA, MOC-31, E-cadherin and CK in the AC group showed high positive rates（88% ,97% ,89% ,92% and 94% respectively） ,whereas the positive rates of VIM and desmin were low （6% and 11% respectively） ;The results of VIM and desmin,in group showed high positivity with 84% and 91% ,respectively,whereas the results of CEA,EMA, MOC-31 and E-cadherin showed low positivity with 13% ,16% ,9% and 6%, respectively. The VIM, desmin and CK in the MM group showed high positivity all were 100%. Conclusions Immunocytochemistry study using a panel of monoclonal antibodies is helpful in differential diagnosis between malignant and benign lesions in effusion smears.

关 键 词：免疫细胞化学 浆膜腔积液 腺癌 反应性增生的间皮细胞 恶性间皮瘤 

分 类 号：R739.45[医药卫生—肿瘤]