内镜标本端粒酶定量检测对良恶性梗阻性黄疸的诊断价值

Diagnosic usefulness of quantitative detection of telomerase from endoscopic specimens in benigh and malignant obstructive jaundice

目的 为探讨胆胰系统恶性肿瘤组织与端粒酶表达的关系 ,并在术前找出一种简便、安全、快速的早期诊断及鉴别良、恶性梗阻性黄疸的方法。方法 对梗阻性黄疸病例于术前行内镜逆行胰胆管造影 (ERCP)检查 ,于造影前抽取胆汁或胰液、部分病例取活检组织 ,并于开腹手术当中再次切取癌组织标本 ,所有标本进行端粒酶活性的定量检测 ,所得数据进行统计学处理。结果 (1)恶性梗阻性黄疸组织标本中端粒酶表达阳性率为 87 5 0 % (2 8/ 32 ) ,良性梗阻性黄疸组织标本中端粒酶表达阳性率为 3 33% (1/ 30 ) ;(2 )恶性梗阻性黄疸体液标本中端粒酶表达阳性率为 71 88% (2 3/ 32 ) ,良性梗阻性黄疸体液标本中端粒酶表达阳性率为 3 33% (1/ 30 ) ,恶性梗阻性黄疸内镜下钳取的活检组织 ,其端粒酶阳性率为 83 33% (10 / 12 )。结论 在术前通过十二指肠镜采集患者的胆汁和胰液 ,并钳取活检组织 ,分别进行端粒酶活性的定量检测 ,这是一种简便、安全、快速的早期诊断及鉴别良、恶性梗阻性黄疸的方法。

Objective To explore the relationship between the expression of telomerase and biliary-pancreatic cancer, and to find out a quick, safe and reliable method to distinguish between malignance jaundice and benign jaundice before operation. Methods ERCP were performed in patients with obstructive jaundice before operation. Bile and pancreatic juice were collected before ERCP, and biopsy specimens from patients were obtained. Fixed quantity of telomerase activity was assessed. Results The positive rate of telomerase activity in patients with maligant obstructive jaundice was 87.5% (28/32), while the positive rate was only 3.33% (1/30) in the tissue of the patient with benign obstructive jaundice. Positive expression rate of telomerase was 71.88% (23/32) and 3.33% (1/30) in body fluid specimens from patients with malignant and benign obstructive jaundice respectively. The positive rate of telomerase in malignant tissue obtained under endoscopy in patients with obstructive jaundice was 83.33% (10/12). Conclusions It is simple safe and quick to distinguish between the malignant and benign obstructive jaundice by detecting the telomerase activity fluid and biopsy spevinens collected under the guidance of duodenoscopy before operation.