FCM-DNA倍体分析、AgNOR染色及hTERT、PCNA表达在良恶性胸腹水鉴别诊断中的临床意义

Significance of FCM-DNA Ploidy Pattern, AgNOR Counting, hTERT and PCNA Expression in Differentiating Malignant from Benign Serous Effusion

背景与目的:良恶性胸腹水的鉴别诊断仍然是临床的一大难题,本研究应用流式细胞仪(flow cytometry,FCM)-DNA倍体分析、核仁组成区嗜银蛋白(argyrophilic nucleolar organizer region,AgNOR)染色及端粒酶逆转录酶(human telomerase reverse transcriptase,hTERT)、增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)的表达来探讨其对良恶性胸腹水的鉴别诊断价值。方法:选取2004年6月至2005年6月间因胸腹水就诊的患者67例,每位患者除常规胸腹水脱落细胞学检查外,还分别进行FCM-DNA倍体分析、AgNOR染色和应用免疫细胞化学SP法检测胸腹水脱落细胞hTERT和PCNA的表达状况。结果:FCM-DNA倍体分析、AgNOR染色及hTERT、PCNA的表达在良恶性胸腹水之间差异显著。上述诸指标与细胞学比较显示,AgNOR染色敏感性最高为89.1%;细胞学及hTERT和PCNA检测特异性最高,为100%;而AgNOR染色及hTERT检测准确率最高,为89.6%。联合检测发现细胞学联合hTERT检测敏感性提高至91.3%(42/46)。结论:DNA异倍体、hTERT和PCNA的表达及AgNOR颗粒数增多均是恶性胸腹水的特征,可作为胸腹水脱落细胞学检查的重要辅助手段,而细胞学联合hTERT免疫细胞化学检测可提高单纯细胞学的阳性率。

BACKGROUND ＆ OBJECTIVE. Differentiating malignant from benign serous effusion is still a difficulty in clinic at present. This study was to explore the clinical value of flow cytometry （FCM）-DNA ploidy, argyrophilic nucleolar organizer region （AgNOR） staining, human telomerase reverse transcriptase （hTERT） and proliferating cell nuclear antigen （PCNA） expression in differentiating malignant from benign serous effusion, METHODS, Sixty-seven patients with serous effusion, treated in People＇s Hospital of Huaibei City from Jun. 2004 to Jun. 2005, were selected. Besides routine exfoliated cytology examination, FCM-DNA ploidy analysis and AgNOR staining was performed, hTERT and PCNA expression were detected by SP immunocytology. RESULTS, There were significant differences in FCM-DNA ploidy, AgNOR staining, hTERT and PCNA expression between malignant and benign serous effusion. Compared with exfoliated cytology, the sensitivity of AgNOR staining was the highest （89.1%）, the specificity of cytology, hTERT and PCNA expression was the highest （100%）, and the accuracy of AgNOR staining and hTERT expression was the highest （89.6%）. According to combination examination, the sensitivity was increased to 91.3% through combining cytology with hTERT expression. CONCLUSION, DNA aneuploidy, hTERT and PCNA expression and AgNOR counting increase are correlated to malignant serous effusion, and can be important auxiliary measures for serous cytology.