非小细胞肺癌特异性循环肿瘤细胞的检测及其临床意义  

A preliminary study on the detection of specific circulating lung cancer cells by flow cytometry for non-small cell lung cancer

作　　者：凌芸 王芳[1] 朱全[2] 徐婷 杨瑞霞 王鹏[1] 李大千 吴蕾 陈亮[2] 潘世扬 

机构地区：[1]南京医科大学第一附属医院检验学部,210029 [2]南京医科大学第一附属医院胸心外科,210029

出　　处：《中华检验医学杂志》2013年第11期1002-1007,共6页Chinese Journal of Laboratory Medicine

基　　金：国家自然科学基金资助项目（81371894,81272324,81000754,81101322,81201359）;国家临床检验重点专科建设项目基金资助;江苏高校优势学科建设工程基金项目资助课题;江苏省实验诊断学重点实验室基金资助项目（XK 201114）

摘　　要：目的 探讨流式细胞术检测非小细胞肺癌（NSCLC）特异性循环肺癌细胞（SCLCC）的临床应用价值.方法 采用特异性识别SPC-A1的单克隆抗体NJ001进行荧光标记,建立流式细胞术检测SCLCC的方法.采用病例对照研究方法,对收集到的2013年3至7月南京医科大学第一附属医院43例NSCLC患者、15例肺部良性疾病患者和35名健康对照者外周血进行SCLCC水平检测,用秩和检验分析各组之间的差异,并绘制ROC曲线分析.同时将43例NSCLC患者的SCLCC水平与电化学发光法检测癌胚抗原（CEA）、角质蛋白19片段（CYFRA21-1）和神经元特异性烯醇化酶（NSE）水平采用x2检验进行比较.结果 NSCLC患者的SCLCC水平为75（16～128）/20万个PBMC,高于肺部良性疾病患者的5（0 ～30）/20万个PBMC和健康对照者的0（0 ～15）/20万个PBMC,差异有统计学意义（Z=-3.373、-5.240,P＜0.05）;NSCLC患者SCLCC的ROC曲线下面积为0.831,最佳诊断临界值为30/20万个PBMC,对应的敏感度为65％,特异度为92％;其中25例NSCLC患者手术之前的SCLCC为78（12～120）/20万个PBMC,显著高于手术之后的17（0～104）/20万个PBMC,差异有统计学意义（Z=-2.005,P＜0.05）;另外43例NSCLC患者的SCLCC阳性率为65％,显著高于电化学发光法的CEA、CYFRA21-1和NSE（35％、14％和23％）,差异有统计学意义（x2=5.76、16.96、13.14,P＜0.05）.结论 应用流式细胞术检测SCLCC具有较高敏感度、特异度和准确性,具有重要的临床价值.Objective To explore the clinical application value of flow cytometry in detecting specific circulating lung cancer cell （SCLCC） for non-small cell lung cancer （NSCLC）.Methods The flow cytometry was established by fluorescent monoclonal antibody NJ001 which can specific recognize the SPC-A1.On basis of detecting the SCLCC,a case-control study was conducted.43 NSCLC patients were compared with 15 benign lung disease patients and 35 healthy controls from the First Affiliated Hospital of Nanjing Medical University by rank-sum test.The difference was also evaluated between before and after surgery for 25 NSCLC patients.The data were analyzed by ROC curve to assess the diagnostic value.Meanwhile,CEA,CYFRA21-1 and NSE were measured by ECLIA for comparison with SCLCC in 43 NSCLC patients by chisquare test.Results The levels of SCLCC in patients of NSCLC,benign lung disease and healthy controls were 75 （16-128）/200000 PBMC,5 （0-30）/200 000 PBMC,0 （0-15）/200 000 PBMC.The SCLCC of NSCLC patients were obviously higher than that of benign lung disease patients and healthy controls （Z =-3.373,-5.240,P ＜ 0.05）.According to ROC curve,the area under the curve was 0.831 and the optimal diagnostic critical value was 30/200 000 PBMC,with higher sensitivity （65％） and specificity （92％）.The levels of SCLCC before and after surgery in 25 NSCLC patients were 78 （12-120）/200000PBMC and 17（0-104）/200000 PBMC.There were significant differences between them（Z =-2.005,P＜0.05）.Meanwhile,the positive rate of SCLCC in NSCLC was 65％,and obviously higher than the positive rate of CEA （35％,x2 =5.76,P ＜ 0.05）,CYFRA21-1 （14％,x2 =16.96,P ＜ 0.05） and NSE（23％,x2 =13.14,P ＜ 0.05）.Conclusion Determination of SCLCC by flow cytometry for NSCLC had higher sensitivity,specificity and clinical value,which suggested that it is a valuable detection technology for NSCLC.

关 键 词：肺肿瘤 癌 非小细胞肺 肿瘤循环细胞 流式细胞术 

分 类 号：R734.2[医药卫生—肿瘤]