尿核基质蛋白22在复发性膀胱尿路上皮癌术后监测中的作用  

Clinical Study on the value of NMP22 in the monitoring of recurrent bladder cancer

作　　者：张立国[1] 曹凤宏[1] 张长江[2] 康绍叁[1] 高伟兴[1] 李晓强[1] 丁雪飞[1] 

机构地区：[1]华北煤碳医学院附属医院泌尿外科,唐山市063000 [2]华北煤碳医学院附属开滦医院泌尿外科

出　　处：《北京医学》2010年第2期116-118,共3页Beijing Medical Journal

基　　金：河北省2009科学技术研究与发展指令计划(项目编号09276101D-13)

摘　　要：目的评价尿核基质蛋白22(NMP22)在膀胱尿路上皮癌术后监测中的临床意义,并与尿细胞学检查相比较。方法留取117例有膀胱尿路上皮癌病史患者的晨尿,应用免疫酶标记法(ELISA法)检测尿中NMP22的数值,同时行尿细胞学检查。所有患者均行膀胱镜检查,并对肿瘤或可疑病变处取膀胱组织送病检,以病理学为最后诊断标准。分析NMP22、尿细胞学检查结果与复发膀胱尿路上皮癌分期、分级的相关性。结果膀胱镜证实39例患者复发。NMP22以6.4U/ml为临界值,阳性33例,NMP22的敏感性为84.6%;尿细胞学检查阳性16例,敏感性为41.2%,两者之间有显著性差异(P﹤0.05)。NMP22对于低级别膀胱尿路上皮癌敏感性是细胞学的8倍。NMP22与细胞学特异性分别为74.2%和92.1%。两者联合检测敏感性增加至91%。结论所有分期、分级的复发膀胱尿路上皮癌NMP22的敏感性均高于尿细胞学检查,两者联合可以提高诊断的敏感性,但在随访过程中尚不能完全取代膀胱镜检查。Objective To assess the clinical value of the NMP22 Bladder Chek test, which is a qualitative test, and to compare it with voided urine cytology for the detection of recurrent bladder cancer. Methods The urine samples before a cystoscopic examination were collected in a total of 117 patients with a history of superficial transitional cell carcinoma of the bladder. Urine samples were assayed for the presence of NMP22 using the NMP22 Bladder Chek test and cytology was performed by a cytopathologist. Selected patients underwent a biopsy, with appropriate additional therapy. Results The two tests were compared with the results of pathology, which was retained as the gold standard. For positive biopsies, the results of the NMP22 test and cytology were also correlated with the tumor stage and grade. Results Of the 39 recurrences detected by cystoscopy, the NMP22 test was positive in 33 cases and cytology in 16 cases. The sensitivity of the NMP22 test was 84.6%, which was significantly higher than that of cytology （41.2%）. In particular, for low-risk tumors it was eight times more sensitive than cytology. The specificities of the NMP22 test and cytology were 74.2 and 92.1%, respectively. Combining the two tests increased overall sensitivity to 91%. Conclusions The NMP22 test is superior to cytology for all grades and stages in the detection of recurrence in patients with a history of superficial bladder cancer. Our study indicates that the NMP22 test can be used as a substitute for urine cytology. The NMP22 test cannot replace cystoscopy, but it can be used as an adjunct to cystoscopy in the surveillance of patients with superficial bladder cancer.

关 键 词：膀胱肿瘤 尿核基质蛋白22 复发 

分 类 号：R737.14[医药卫生—肿瘤] R737.1[医药卫生—临床医学]