肺癌痰液p53和K-ras基因及端粒酶联合检测的临床研究

Clinical research on the mutative rates of p53, K-ras and the activity of telomerase in the sputum of lung cancer

目的:从肿瘤分子生物学角度探讨痰液多基因、多因素联合检测对肺癌早期诊断、病情预后及肿瘤防治方面的意义。方法:采用聚合酶链反应-单链构象多肽性分析(PCR-SS-CP)方法和聚合酶链反应-酶联免疫吸附测定法(PCR-TRAP-ELISA)检测55例经病检确诊的肺癌患者痰中p53和K-ras基因突变率及端粒酶活性。结果:55例肺癌患者痰中,p53、K-ras基因突变率和端粒酶阳性率分别为61·8%、40·0%和58·2%,且有11例三项指标均异常。23例肺良性病患者p53、K-ras基因突变率和端粒酶阳性率分别为21·7%、8·7%和30·4%,两组比较差异有统计学意义,P<0·01。三项指标异常与肿瘤组织类型、临床分期及是否化疗差异无统计学意义(P>0·05),与吸烟差异有统计学意义(P<0·05)。联合检测的检出率明显高于单因素变异的检出率,P<0·05。结论:联合检测可提高肿瘤早期诊断的敏感性和检出率,并对判断疾病的性质及病情预后有一定的指导意义。痰液检测无创、简便,患者依从性好。

OBJECTIVE：To investigate the significance of the sputum polygene and multifactor combining detection in early diagnosis, prognosis and prevention of lung cancer from the point of view of the tumor molecular. METHODS：PCR-SSCP and PCR-TRAP-ELISA were used to detect the mutative rates of p53,K-ras and the activity of telomerase in the sputum of 55 lung cancer patients diagnosed by biopsy. RESULTS： p53 and K-ras mutative rates and telomerase positive rate in 55 lung cancer patients were 61.8%, 40. 0% and 58. 2% respectively and 11 cases had all the 3 indices abnormal, and p53 and K-ras mutarive rates and telomerase positive rate in 23 cases with benign lung disease were 21.7% ,8. 7% and 30. 4% respectively. The difference was highly significant （P〈0. 01） between the two groups. The abnormality of these 3 indices had no correlation with tumor tissue type, clinical grade and chemical therapy or not （P〉0. 05）,but was significantly associated with smoking,P〈0. 05. The detectable rate by combining detection was significantly higher than that by single index deteetion,P〈0. 05. CONCLUSIONS.. The sputum polygene and multifactor combining detection can improve sensitivity and detectable rate of early lung cancer diagnosis, and has instructive significance for the judgement of the property and prognosis of the disease. The detection of sputum is safe and convenient. The compliance of patients is good.