CD_(45)抗体标记与碘化丙啶染色法DNA倍体分析在良恶性胸腔积液鉴别诊断中的意义

Value of CD_(45) and PI staining method in identifying malignant from benign pleural effusion by dna analysis

目的探讨 CD_(45)抗体标记+碘化丙啶(PI)染色法(简称CD_(45)+PI法)进行 DNA 倍体分析对提高恶性胸腔积液检出率的意义。方法对28例临床确诊为肿瘤患者的恶性胸腔积液及20例结核病患者的胸腔积液,分别采用3种方法进行分析:(1)细胞形态学检查法(简称形态法);(2)PJ染色法,PI 染色后进行流式 DNA 倍体分析(简称 PI 法);(3)CD_(45)+PI 法,即先用 CD_(45)抗体标记细胞表面抗原,再用PI染色进行流式 DNA 倍体分析。比较3种方法的敏感度、特异度和准确性;比较异倍体细胞含量较低(≤3.64%)的标本中,PI 法和 CD_(45)+PI 法进行 DNA 倍体分析的 DNA 指数(DI)值差异。结果 CD_(45)+PI 法的敏感度为89%高于形态法及普通 PI 法的36%和71%,且特异度(95%)较PI 法(79%)高,在3种方法中 CD_(45)^+PI 法准确性最高,为92%。对肿瘤细胞含量较低,异倍体细胞较少的标本,PI 法分析 DI 值为正常;而用CD_(45)+PI 法分析 DI 值却可以检出肿瘤异倍体。结论 CD_(45)+PI 法进行 DNA 倍体分析较之普通 PI 法可以检测到更低含量的异倍体细胞,有助于提高良恶性胸腔积液的鉴别诊断水平。

Objective To explore the diagnostic value of CD45 and PI staining short for CD45 ＋ PI method） in identifying malignant from benign pleural effusion by DNA analysis. Methods Check the malignant pleural effusion in patients with cancer and benign pleural effusion in patients with tuberculosis by three methods： （ 1 ）Microscope method, （2）PI staining method： Cell from pleural effusion stained with PI for DNA cycle analysis of flow cytometry （short for PI method）, （3） CD45 ＋PI method,which is to stain the cell with CD45 first and PI later for DNA cycle analysis of flow cytometry. Compare three methods in sensitivity, specificity and accuracy; Compare PI method and CD45 ＋ PI method for DNA analysis of flow cytometry in samples with low aneuploidy content （≤3.64% of all）. Results CD45 ＋ PI method was more sensitive than microscope method or conventional PI method, and the sensitivities were 89%, 36%, and 71%, respectively. CD45 ＋ PI method was more specifici than PI method,and the specificities were 95% and 79% respectively. CD45 ＋PI method has shown the best accuracy （92%）among the three methods. In 5 samples with low aneuploidy content,they were normal when analyzed by PI method but abnormal with aneuploidy by CD45 ＋ PI method. Conclusion CD45 ＋ PI method can detect lower content of aneuploidy than the conventional PI method, thus can be used to improve the diagnosis level of malignant from benign pleural effusion.