胆管腔内超声联合细胞刷检病理、基因突变检测对胆管恶性狭窄的早期定性诊断价值  

Early diagnostic value of intraductal ultrasonography combined with cytology brushing and gene mu- tation for malignant biliary stricture

作　　者：黄平[1] 张筱凤[1] 张啸[1] 吕文[1] 范震[1] 黄海涛[1] 王霞[1] 余道军[2] 

机构地区：[1]浙江省杭州市第一人民医院消化内科,310006 [2]浙江省杭州市第一人民医院基因实验室

出　　处：《中华消化内镜杂志》2014年第12期685-689,共5页Chinese Journal of Digestive Endoscopy

基　　金：浙江省医药卫生科技计划（2012KYB144）

摘　　要：目的探讨胆管腔内超声（IDUS）联合细胞刷检病理学、细胞刷检标本K-ras和p53基因突变检测对胆管恶性狭窄的早期定性诊断价值。方法84例疑似胆管恶性狭窄患者首先行IDUS检查，随后用细胞刷刷取狭窄段胆管内壁标本，一份送检病理，另一份行K-ras、p53基因突变检测，以病理及随访结果为最终诊断，统计单一检查方法及联合检查方法早期诊断胆管恶性狭窄的敏感度、特异度、阳性预测值、阴性预测值和准确率，并行对比分析。结果单一检查诊断时，IDUS、细胞刷检病理学、细胞刷检标本K-ras基因突变检测和细胞刷检标本p53基因突变检测敏感度分别为63．46％（33／52）、53．85％（28／52）、38．46％（20／52）和42．31％（22／52），准确率分别为69．05％（58／84）、71．43％（60／84）、61．90％（52／84）和64．29％（54／84）。联合检查诊断时，IDUS＋细胞刷检病理学＋细胞刷检标本K-ras和p53基因突变检测敏感度（96．15％，50／52）、特异度（93．75％，30／32）、阳性预测值（96．15％，50／52）、阴性预测值（93．75％，30／32）和准确率（95．24％，80／84）均最高，且诊断敏感度和准确率均较单一检查诊断时有明显提升（P〈0．05）。结论胆管腔内超声联合细胞刷检病理、细胞刷检标本K-ras和p53基因突变检测有助于胆管恶性狭窄的早期定性诊断。Objective To study the value of intraduetal ultrasonography （IDUS）, cytology brushing and K-ras, p53 gene mutation for the early diaguosis of malignant biliary stricture. Methods IDUS was per- formed on 84 patients with suspected malignant biliary stricture, followed by cytology brushing. Specimens were sent to the department of pathology and genetic lab for K-ras,p53 gene mutation detection. The final diag- nosis of all patients was based on pathology and follow-up results. The sensitivity, specificity, positive predic- tive value, negative predictive value, and accuracy of single inspection method and the joint inspection method in the early diagnosis for malignant biliary stricture were evaluated and compared. Results In single diagno- sis, the sensitivity of IDUS, cytology brushing and K-ras, p53 gene mutation were 63.46% （33/52）, 53.85% （28/52）, 38.46% （20/52） and 42.31% （22/52）. And the accuracy rates were 69.05% （58/84）, 71.43% （60/84）, 61.90% （52/84） and 64. 29% （54/84） respectively. In combined diagnosis, IDUS combined with cytology brushing and K-ras, p53 gene mutation had the highest sensitivity （96. 15%, 50/52）, specificity （93.75%, 30/32）, positive predictive value （96. 15%, 50/52）, and negative predictive value （93. 75%, 30/32） and accuracy （95. 24%, 80/84）. The sensitivity and accuracy were significantly higher than single diagnosis （P 〈 0. 05 ）. Conchtsion IDUS combined with cytology brushing and K-ras, p53 gene mutation detection facilitates the early diagnosis of malignant biliary stricture.

关 键 词：诊断 胆管恶性狭窄 胆管腔内超声 细胞刷 K-RAS基因 P53基因 

分 类 号：R655[医药卫生—外科学]