联合检测UBC、HA和CK20诊断膀胱癌的临床价值  

Clinical Value of Combined Detection with Urinary Bladder Cancer Antigen,Hyaluronic Acid and Cytokeratin 20 in Diagnosis of Bladder Cancer

作　　者：蒲小勇[1] 王志平[2] 陈一戎[2] 吴一龙[3] 王怀鹏[1] 王行环[1] 

机构地区：[1]广东省人民医院泌尿外科,广东广州510080 [2]兰州大学第二医院泌尿外科研究所,甘肃兰州730000 [3]广东省人民医院肿瘤中心,广东广州510080

出　　处：《癌症》2008年第9期970-973,共4页Chinese Journal of Cancer

基　　金：中国博士后科学基金(No.20060400779);广东省医学科研基金(No.A2007028)~~

摘　　要：背景与目的:膀胱癌是最常见的泌尿系统肿瘤,尿脱落细胞学检查是无创性诊断的金标准,但敏感性较低。本研究探讨联合运用尿膀胱癌抗原(urinary bladder cancer,UBC)、透明质酸(hyaluronic acid,HA)和细胞角蛋白20(cyto keratin20,CK20)诊断膀胱癌的临床价值。方法:对64例膀胱癌患者、20例泌尿系良性疾病患者,在膀胱镜检查之前留尿,分别采用酶链免疫吸附实验、放射免疫分析和逆转录聚合酶链反应检测UBC、HA和CK20在尿液中的表达,同时行脱落细胞学检查,分析比较4种方法诊断膀胱癌的临床价值。结果:UBC、HA和CK20诊断膀胱癌的敏感性分别为85.9%(55/64)、89.1%(57/64)、78.1%(50/64),与脱落细胞学(40.6%)检查比较,差异有统计学意义(P<0.01);4种方法诊断膀胱癌的特异性分别为85.0%(17/20)、80.0%(16/20)、80%(16/20)和95%(19/20)。各分级和分期肿瘤UBC、HA和CK20的敏感性分别高于尿脱落细胞学检查,UBC值各分级和分期比较差异无统计学意义(P>0.05)。HA检测G2、G3组较G1组明显增高(P<0.01),但G2、G3组间比较差异无统计学意义(P>0.05);各分期之间比较差异无统计学意义(P>0.05)。CK20检测随肿瘤的分级与分期的增高,敏感性增高(P<0.01)。联合运用UBC、HA和CK20敏感性可达96.9%,特异性达100%。结论:联合UBC、HA和CK20能提高诊断膀胱癌的敏感性和特异性,初步诊断能够代替膀胱镜检查。BACGROUND ＆ OBJECTIVE： Bladder cancer is the most common malignancy of all genitourinary tumors. Urine cytology is the ＂gold standard＂ for non-invasive diagnosis of bladder cancer, but its sensitivity is low. This study was to explore the clinical value of combined detection with urinary bladder cancer antigen （UBC）, hyaluronic acid （HA） and cytokeratin 20 （CK20） in the diagnosis of bladder cancer. METHODS： Urine samples were obtained from 64 patients with bladder cancer and 20 patients with benign urological disease. Urine UBC, HA and CD20 were measured using enzyme-linked immunosorbent assay （ELISA）, radioimmunology assay, and reverse transcription polymerase chain reaction （RT-PCR） respectively, before cystoscopy. RESULTS. UBC, HA and CK20 yielded significantly higher sensitivity in detecting bladder cancer compared to urinary cytology （85.9%, 89.1% and 78.1% vs. 40.6%, P〈 0.01）. The specificity of UBC, HA, CK20 and urinary cytology for the detection of bladder cancer were 85.0%, 80.0%, 80.0% and 95.0%, respectively. The sensitivity of UBC, HA and CK20 were all significantly higher than that of urinary cytology in detecting different histological stages and grades of bladder cancer （P〈0.01）. The value of UBC had no significant difference in different histological stages and grades of bladder cancer （P〉0.05）. The sensitivity of HA was significantly higher in G2 and G3 grades than in G1 grade （P〈0.01）, but not different between G2 and G3 grades （P〉0.05）. No difference in HA values was observed between different histological types （P〉0.05） regarding to HA. The sensitivity of CK20 was significantly elevated with the increase of histological grades and stages. Combined use of UBC, HA and CK20 improved the sensitivity and specificity of detecting bladder cancer to 96.9% （62/64） and 100.0%, respectively. CONCLUSIONS- Combined use of UBC, HA and CK20 can improve the sensitivity and specificity for the detection of bladder cancer in urine, thus it ma

关 键 词：膀胱肿瘤 细胞角蛋白 透明质酸 诊断 

分 类 号：R737.14[医药卫生—肿瘤]