尿纤维连接蛋白在诊断上尿路移行细胞癌的临床意义_检验世界网

　　作者：凌海滨 赵莹 李向东 苗文隆 李凤歧 成日青

　　【摘要】  目的: 探讨尿纤维连接蛋白(fibronectin,Fn)与上尿路移行细胞癌的生物学关系。方法: 采用ELISA法检测30例上尿路移行细胞癌、25例其它泌尿系疾病患者及20例正常人尿液Fn含量，并同时测定尿肌酐（Creatin,Cr），计算Fn/Cr比值，比较各组人群尿Fn/Cr比值之间的差异；分析不同肿瘤分期、分级尿Fn/Cr之间的差异；比较其与尿脱落细胞学检测上尿路移行细胞癌的敏感性。结果: 上尿路移行细胞癌尿Fn/Cr比值为（46.4±26.5）mg/mol，明显高于正常人（14.7±8.8）mg/mol及其它泌尿系疾病患者（28.2±22.7）mg/mol。以34mg/mol为标准，尿Fn/Cr比值诊断上尿路移行细胞癌的灵敏度和特异度分别为73.3%和77.8%。尿Fn/Cr比值与上尿路肿瘤分期分级有关。尿脱落细胞学检测上尿路移行细胞癌的敏感性为53.3%，采用Fn/Cr检测较脱落细胞学检查敏感性无统计学意义（P>0.05）。结论: 尿Fn/Cr可作为上尿路移行细胞癌的诊断指标。其高低与膀胱癌的分期、分级有关，可大致判断浸润度和恶性度，并可用于上尿路移行细胞癌的预后评估。

　　【关键词】  尿纤维连接蛋白; 尿纤维连接蛋白/尿肌酐比值; 上尿路; 移行细胞癌

　　【ABSTRACT】  Objective: To investigate the biological relationship between urine fibronectin (Fn) and upper urinary tract transitional cell carcinoma(TCC) in patients. Methods：Urinary Fn was detected by ELISA technique in 30 cases with upper urinary tract TCC, 24 cases with other urogenital diseases and 19 healthy subjects. Meanwhile the analysis for creatin (Cr) in urine was carried out and the Fn/Cr ratio was calculated. The discrepancy of urinary Fn/Cr among three groups and tumor grades and stages was analized as well. Sensitivity and specificity of the urinary Fn/Cr were compared with that of the urinary cytology. Results：The urinary Fn/Cr ratio was significantly higher in upper urinary tract TCC (46.4±26.5mg/mol)than in other urogenital diseases (28.2±22.7mg/mol)and the healthy subjects (14.7±8.8mg/mol) (P<0.01, P<0.05). Taking 34mg/mol for Fn/Cr as standard, The sensitivity and specificity of urinary Fn/Cr ratio were 73.3% and 77.8% respectively. Urinary Fn/Cr ratio had obvious discrepant among tumor grades and stages (P<0.01). Otherwise,the sensitivity was 53.3% for urinary cytology. Conclusions： Urinary Fn/Cr ratio has significant diagnostic value in the patients with upper urinary tract TCC. Obvious relationship between urinary Fn/Cr and the stages or grades has been noted. Determining urinary Fn values may give an idea about the invasive potential of the tumor and may estimate the prognosis.

　　【KEY WORDS】  Urinary fibronectin; Urinary fibronectin /urinary creatin value; Upper urinary tract; Transitional cell carcinoma

　　上尿路移行细胞癌中基底膜Fn有不同程度丧失，这样使尿液中Fn含量有所变化。Fn在诊断膀胱癌并估测预后的意义已有相关报道[1～3]。本实验拟通过检测尿Fn含量在上尿路移行细胞癌患者、正常人及其它泌尿系疾病患者中的变化，证实尿Fn在上尿路移行细胞癌中的临床应用价值。

　　1  资料和方法

　　1.1  一般资料

　　1.1.1  上尿路移行细胞癌组  30例，男21例，女9例；年龄：42～80岁，平均63岁；肾盂癌23例，其中Ⅰ期4例，Ⅱ期15例，Ⅲ期3例，Ⅳ期1例；输尿管癌7例，其中Ⅰ期3例，Ⅱ期2例，Ⅲ期1例，Ⅳ期1例。Ⅳ期以前患者均手术治疗。

　　1.1.2  其它泌尿系疾病组   25例，男14例，女11例；年龄30～78岁，平均60岁；其中BPH2例，肾囊肿2例，肾结石4例，输尿管结石4例，输尿管息肉2例，肾盂/膀胱炎2例，肾癌3例，肾结核2例，输尿管炎性狭窄4例。

　　1.1.3  正常对照组  20例，男12例，女8例；年龄24～77岁，平均58岁。

　　1.2  方法

　　1.2.1  标本采集  前一天晚上10时后禁水。留取清晨第一次全程尿液，分为两份，一份送检验科检测尿Cr，另一份则在离心机3000r/min离心后，收集上清液，置于干净的试管，封盖，于-80℃保存。离心后尿沉渣行尿脱落细胞学检查。

　　1.2.2  标本检测  ELISA法测定尿Fn，单位μg/L。试剂盒由DR Lab California提供。测定尿Cr，单位μmol/L。计算Fn/Cr比值，单位mg/mol。

　　1.2.3  结果计算&n