尿液细胞型纤维连接蛋白在膀胱癌诊断和术后监测中的价值  

Urinary cellular fibronectin in diagnosis and postoperative surveillance of bladder cancer

作　　者：缪起龙[1] 李忠义[1] 邵法明[1] 王卫华[1] 许天源[2] 屠凡倬[2] 张敏光[2] 沈周俊[2] 

机构地区：[1]宁波大学医学院附属医院泌尿外科,315020 [2]上海交通大学医学院附属瑞金医院泌尿外科

出　　处：《中华泌尿外科杂志》2013年第12期924-928,共5页Chinese Journal of Urology

基　　金：宁波市自然科学基金资助（2008A610086）

摘　　要：目的探讨尿液中细胞型纤维连接蛋白（cellularfibronectin，cFN）浓度在膀胱癌诊断、预后和术后监测中的价值。方法选取2010年8月至2012年2月收治的52例膀胱癌术前患者（术前组），男36例，女16例。年龄4l～88岁，平均62岁。T1期28例，T2期18例，T3期5例，T4期l例。G1级30例，G2级5例，G3级17例。27例术后无肿瘤残余患者（无残余组），男18例，女9例。年龄48～83岁，平均66岁。其中初次手术行TURBT22例，膀胱部分切除术5例。术后病理分期：T1期12例，T2期11例，T3期4例；病理分级：G1级14例，G2级4例，G3级9例。8例术后肿瘤残余患者（残余组），男6例，女2例。年龄49～75岁，平均62岁。6例初次手术行TURBT，2例行膀胱部分切除术。术后病理分期：T1期3例，T2期4例，T3期1例；病理分级：G1级3例，G2级1例、G3级4例。同期健康志愿者17例为对照组，男12例，女5例。年龄34～72岁，平均45岁。留取4组的尿液标本，通过酶联免疫吸附试验检测尿cFN浓度，比较各组尿cFN浓度的差异。将术前组患者根据肿瘤分期、分级和大小分别分为非肌层浸润组（T1期）和肌层浸润组（T2～T4期）；低分级组（G1～G2级）和高分级组（G，级）；小肿瘤组（肿瘤直径〈3cm）和大肿瘤组（直径≥3cm），分析肿瘤预后相关临床病理参数与术前尿cFN浓度的关系。绘制受试者工作特征（ROC）曲线，评价尿液cFN检测膀胱癌术后肿瘤残余的能力。结果术前组、无残余组、残余组和对照组尿cFN浓度分别为（1809．78±1657．39）、（878．7l±355．68）、（1311．67±500．09）、（898．50±318．98）vg／L，术前组尿cFN浓度与无残余组和对照组比较，差异均有统计学意义（P〈O．05）；残余组尿cFN浓度显著高于无残余组与对照组，差异均有统计学意义（P〈0．05），但与术前组比较差异无统计学意义（P〉O．05）。肌层浸�Objective To investigate the value of urinary eellular fibroneetin （eFN） in diagnosis, prognosis and postoperative surveillance of bladder cancer. Methods Urinary cFN were determined in 52 patients preoperatively （preoperative group ）, and in 27 patients without residual turnout （no residual group） , 8 patients with residual tumour （residual group） postoperatively, as well as 17 healthy volunteers（control group） from Aug 2010 to Feb 2011 by Enzym-Linked immunosorbent Assay （ELISA） test. The differences in cFN levels among groups were analyzd. Based on T stage, grade and tumor size, 52 patients in the preoperative group were divided into nonmuscle-invasive group （T1 stage） and muscle-invasive group （ T2-T4 stage）, low-grade group （ G, -G2 ） and high-grade group （ G3 ）, and small tumor group （ diameter〈 3 cm） and large tumor group （ diameter ≥ 3 cm） , respectively. Relationship between preoperative urinary cFN levels and tumor clinicopathologic factors was analyzed. A receiver operating characteristic （ROC） curve was plotted to determine the ability of urinary cFN to distinguish patients with and without residual tumor. Results The levels of urinary cFN in both preoparative group （ 1809.78± 1657.39 μg/L） and re- sidual group （1311.67±500.09 μg/L） were significantly higher than those of no residual group （878.71± 355.68 μg/L） and those of control group （898.50±318.98 μg/L）, respectively （P〈0.05）. No significant difference was observed between residual group and preoperative group （P〉O.05）. Preoperative urinary cFN levels were associated with tumor clinicopathologic factors and significantly higher values were observed in muscle-invasive group （2188.67±2048.93 vs 1485.02±1150.69 μg/L, P〈O.05） and large tumor group （3643.59±2673.89 vs 1373.16±876.88 μg/L, P〈0.05）. There was also a significant correlation of urinary cFN levels with tumor size （r= 0.471, P〈0.05）. The ROC curve showed a sensitivity of 75% a

关 键 词：细胞型纤维连接蛋白 膀胱癌 诊断 术后监测 

分 类 号：R737.14[医药卫生—肿瘤]