纤维支气管镜刷检细胞核内不均一核糖核蛋白B_1染色诊断肺癌价值的研究

Diagnostic value of heterogeneous nuclear ribonucleoprotein B_1 in lung cancer in bronchoscopy brush specimens

目的 探讨纤维支气管镜刷检细胞核内不均一核糖核蛋白B1(HnRNPB1)染色在肺癌诊断中的价值。方法 对 381例病理检查证实的肺癌患者及 10 0例非肺癌患者 ,经纤维支气管镜刷检脱落细胞涂片 ,采用抗HnRNPB1单克隆抗体免疫细胞化学染色 ,研究HnRNPB1诊断肺癌的敏感性与特异性 ,并与传统的CT及痰脱落细胞学检查进行比较。结果 381例肺癌患者均经纤维支气管镜检查于病变所在叶支气管进行刷检涂片 ,HE染色脱落细胞学检查发现癌细胞 2 18例 ,采用抗HnRNPB1单克隆抗体免疫细胞学检查 ,2 0 8例样本可见HnRNPB1染色。在癌细胞阴性的 16 3例样本中HnRNPB1染色阳性 12 1例 ,癌细胞阳性与阴性组间HnRNPB1表达有明显差异 (P <0 .0 5 )。不同病理类型肺癌的HnRNPB1表达为 :鳞癌 2 19例 ,HnRNPB1染色阳性 197例 (90 .0 % ) ;腺癌 10 8例 ,HnRNPB1染色阳性 85例 (78.7% ) ;小细胞癌 5 4例 ,HnRNPB1染色阳性 4 7例 (87.0 % )。鳞癌及小细胞肺癌HnRNPB1表达阳性率高于腺癌 (P <0 .0 5 )。HnRNPB1免疫细胞化学染色诊断肺癌的敏感性为 86 .4 % ,特异性为 91% ,假阴性率为 13.6 % ,假阳性率为 9% ,阴性提示率为 6 3.6 % ,阳性提示率为 97.3%。结论 HnRNPB1免疫细胞学检查诊断肺癌的敏感性明显优于痰脱落细胞学检查 。

Objective To explore the clinical value of heterogeneous nuclear ribonucleoprotein (HnRNP) B 1 in the detection of lung cancer in bronchial brush samples.Methods 381 lung cancer individuals identified by pathology and 100 non lung cancer individuals were recruited in a prospective study.All of the individuals were examined with bronchoscopy and bronchoscopy brush.The bronchoscopy brush specimens were stained with anti-hnRNP B 1 monoclonal antibody using immunocytochemical method.The diagnostic value of HnRNP B 1 in lung cancer was compared with routine diagnostic cytology.Results 218 of 381 specimens with lung cancer underwent cytological studies were reported to find malignant cells.208 of 218 specimens with positive cytological findings were staining with HnRNP B 1 monoclonal antibody.However,in 163 specimens that were reported as cytologically negative,121 also demonstrated HnRNP B 1 positive.197 of the 219 squamous cell carcinomas,85 of 108 adenocarcinoma,and 45 of 54 small cell carcinomas demonstrated positive staining with the HnRNP B 1 antibody.The diagnostic sensitivity of HnRNP B 1 positive staining was 86.4%,whereas the specificity was 91%,positive predictive value was 97.3%,false negative rate was 13.6%,false positive rate was 9%,and negative predictive value was 63.6%.Conclusions The sensitivity of HnRNP B 1 positive staining in detection of lung cancer is much better than routine cytological study.The results indicate that HnRNP B 1 is a potential detection marker of lung cancer.