检测腹腔灌洗液中细胞内端粒酶活性对结直肠癌患者的诊断价值

Detection of telomerase activity of cells in peritoneal lavage fluid from patients with colorectal carcinoma

目的探讨测定腹腔灌洗液中细胞内端粒酶活性对检测腹腔中游离癌细胞的敏感性。方法采用原位分子杂交(ISH)技术测定28例结直肠癌患者术始、术毕腹腔灌洗液中细胞内端粒酶活性,同时与常规细胞学检查结果进行比较。结果28例结直肠癌患者术始、术毕腹腔灌洗液中细胞内端粒酶阳性率分别为42.9%(12/28)和21.4%(6/28),P>0.05;差异无显著性意义。常规细胞学检查游离癌细胞阳性率术始、术毕分别为14.3%(4/28)和3.6%(1/28);两者差异也无显著性意义(P>0.05)。术始,腹腔灌洗液中细胞内端粒酶阳性率为42.9%,细胞学检查阳性率为14.3%,两者差异有显著性意义(P<0.05);术毕,腹腔灌洗液中细胞内端粒酶阳性率为21.4%,细胞学检查阳性率为3.6%,两者差异有显著性意义(P<0.05)。原发癌肿已侵出浆膜层者和原发癌肿侵及和未侵及浆膜层者,术始腹腔灌洗液中细胞内端粒酶阳性率分别为73.3%和7.7%,两者差异有非常显著性意义(P<0.01);腹腔灌洗液中细胞内端粒酶阳性与临床原发癌肿侵出浆膜层呈正相关,但与原发癌肿大体类型、组织学类型及有无淋巴结转移均无关(均P>0.05)。结论用ISH技术测定腹腔灌洗液中细胞内端粒酶活性对检测腹腔中游离癌细胞的敏感性明显高于常规细胞学检查。

Objective To check free cancer cells in the peritoneal cavity by detecting telomerase activity of cells in peritoneal lavage fluid before and after resection,and estimate the role of flushing the cavity to clean free cancer cells in the peritoneal cavity. Method Telomerase activity in cells of peritoneal lavage fluid from 28 patients with colorectal carcinoma was detected by using in situ molecular hybridization(ISH)and routine cytologic examination before and after resection. Result The telomerase positive rates of cells from peritoneal lavage fluid before and after resection were 42.9%(12/28),21.4%(6/28),respectively. There was no significant difference (P >0.05).The cytologic positive rates of cells from peritoneal lavage fluid before and after resection were 14.3%(4/28),3.6%(1/28),respectively(P >0.05). In peritoneal lavage fluid before resection,the telomerase positive rate was 42.9%,the cytologic positive rate was 14.3%,there was significant difference(P< 0.05). The telomerase positive rate in peritoneal lavage fluid after resection was 21.4%,the cytologic positive rate was 3.6%.There was significant difference(P< 0.05). The telomerase positive rate in peritoneal lavage fluid before resection was 73.3%in the patients with invasion outside serosal membrane,while 7.7%with serosal membrane invasion or not. There was significant difference(P< 0.01). The telomerase positive rate was not significantly correlated with tumor gross types,histology types and lymph node metastasis(P >0.05). Conclusions The sensitivity of ISH is much higher to detect free cancer cells in the peritoneal cavity than cytologyic examination. Telomerase positive rate is positively correlated with invasion depth. The effect of irrigating peritoneal cavity to clean free cancer cells is poor.