尿及癌组织中Survivin的表达对膀胱癌的早期诊断价值

Early diagnostic value of expression of Survivin in urine and tissue of transitional cell carcinoma

目的通过对膀胱移行上皮癌患者尿脱落细胞及癌组织中抑制凋亡相关基因Survivin的检测,探讨早期发现、常规筛选膀胱癌且无损伤的方法。方法留取53例膀胱移行上皮癌、20例泌尿系其他疾病患者及10例健康志愿者新鲜中段晨尿200 mL,对53例膀胱移行上皮癌患者术后癌组织,用巢式逆转录聚合酶链反应(nested RT-PCR)检测Survivin的表达,同时行尿脱落细胞学检查及膀胱镜取材病检。结果用巢式RT-PCR检测53例膀胱移行上皮癌患者尿及癌组织中Survivin均有表达,所有样本尿中Survivin的表达敏感性为100%,特异性为90%。尿脱落细胞学敏感性为37.7%,特异性为100%。膀胱镜病检敏感性、特异性均为100%。尿及癌组织中Survivin与尿脱落细胞学敏感性比较有显著差异(P<0.05),与膀胱镜检相同。而特异性分别为90%、100%、100%,P>0.05,无差异。结论用巢式RT-PCR方法检测膀胱移行上皮癌患者尿及癌组织中Survivin的表达,其敏感性、特异性相同。尿脱落细胞Survivin表达敏感性、特异性高。尿取材无损伤、方便,敏感性优于尿脱落细胞学检查,与膀胱镜检相当,特异性与尿脱落细胞学检查及膀胱镜病检无差别,且对膀胱癌前病变的归转有一定价值。检测尿中Survivin有望成为临床诊断、筛检膀胱癌的较可靠方法。

Objective To find a scatheless method of early detection and routine screening of bladder cancer, by detecting inhibitor gene of apoptosis, Survivin in voided urine cell and cancer tissue of transitional cell carcinoma of bladder. Methods 200 mL fresh midpiece urina sample was collected from each of the 53 patients of transitional cell carcinoma of bladder, 20 patients of other uropoiesis disease, and 10 healthy volunteers, expression of Survivin was detected by nested RT-PCR. Voided urine cytology and cystoscopy were also conducted. Results Expression of Survivin was found in all 53 cases of bladder transitional epidermal cancer by nested RT-PCR, the sensitivity and specificity of expression of Survivin in all urine samples being100%, and 90% respectively. Sensitivity and specificity of voided urine cytology were 37. 7%, and 100% respectively. The sensitivity and specificity of material in cystoscopy were both 100%. Comparing urine and cancer tissue with voided urine cytology, and cytoscopy sensitivity（P〈 0.01） had significant deviation. While specificity were 90 %, 100 % and 100%, respectivety （P〉0.05）, showing no difference. Conclusion Sensitivity and specificity of urine and cancer tissue are the same by using nested RT-PCR to detect Survivin in bladder transitional epidermal cancer. Sensitivity and specificity of expression of Survivin in voided urine cell are high. What＇s more, taking urine is scatheless and convinient, and its sensitivity is superior to voided urine cytology and equivalent to bladder cystoscopy. Specificity has no difference compared with voided urine cytology and bladder cystoscopy. It is valuable to transfer bladder precancerosis to some degree. Detecting Survivin in urine can be a reliable method diagnosing and screening bladder cancer.