尿纤维连接蛋白在诊断膀胱移行细胞癌中的应用价值

The Clinic Applied Value of Urine Fibronectin in Diagnosis of Bladder Transitional Cell Cancer

目的:评价尿纤维连接蛋白(fibronectin,Fn)在诊断膀胱移行细胞癌中的应用价值,并界定其临床参考值。方法:采用ELISA法检测55例膀胱移行细胞癌患者、34例其他泌尿系疾病患者及29例正常人的尿Fn含量,并同时测定尿肌酐(Creatin,Cr),计算Fn/Cr比值,比较各组人群尿Fn和尿Fn/Cr比值之间的差异;分析不同肿瘤分期、分级尿Fn和尿Fn/Cr之间的差异;利用尿Fn/Cr比值与其它尿生物标志物比较它们之间的优势。结果:膀胱癌组尿Fn含量(583.4±302.5μg/L)、Fn/Cr比值(149.5±93.3mg/mol)与其他泌尿系疾病组Fn含量(209.3±125.0μg/L)、Fn/Cr比值(52.4±36.2mg/mol)以及对照组Fn含量(134.3±83.6μg/L)、Fn/Cr比值(38.2±22.7mg/mol)相比,有显著性差异(P<0.01,P<0.05)。尿Fn诊断膀胱移行细胞癌的灵敏度和特异度分别为78.2%和76.2%,尿Fn/Cr比值分别为81.8%和79.4%。另外,不同分期、分级膀胱癌患者的尿Fn含量及Fn/Cr比值也有明显差异(P<0.05)。比较后提示尿Fn/Cr比值与目前多种分子生物学指标检测膀胱肿瘤的敏感性、特异性基本相似。结论:尿Fn含量及尿Fn/Cr比值在膀胱癌的临床诊断方面有重要的价值,是诊断膀胱癌的一种较理想指标;尿Fn含量及Fn/Cr的高低与膀胱癌的分期、分级有关,可大致判断膀胱癌的浸润度和恶性度,并可用于膀胱癌的预后评估,但目前仍不能代替膀胱镜;界定其临床参考值为250μg/L(Fn)和62mg/mol(Fn/Cr)。

Objective： To evaluate the clinic applied value of urine fibronectin（Fn）in the patients with bladder transitional cell carcinoma（TCC） ;to define the optimal cut-off for urinary Fn and Fn/Cr. Methods： Urinary Fn was detected by ELISA technique in 55 cases with bladder transitional cell cancer,34 cases with other urogenital diseases and 29 cases of healthy subjects. Meanwhile the analysis of creatin（Cr）in urine was carried out and the urinary Fn/Cr ratio was calculated. Analysed the discrepancy of urinary Fn and Fn/Cr among three groups and among tumor grades and stages, were analyzed Sensitivity and specificity of the urinary Fn/Cr compared to the other urinary tumor markers cited in the literature, including the urinary cytology. Results： The urinary Fn and Fn/Cr ratios were significantly higher in bladder cancer（Fn 583. 4±02.5μg/L, Fn/Cr 149.5±3.3mg/mol） than in other urogenital diseases （Fn 209.3±125.0μg/L, Fn/Cr 52.4±6.2 mg/mol） and the healthy subjects （ Fn 134. 3 ± 83. 6μg/L, Fn/Cr38. 2 ± 22.7mg/mol） （ P〈0. 01, P〈0.05 ）. The sensitivity and specificity of urinary Fn were 78. 2% and 76. 2%, respectively in the patients with bladder cancer, while urinary Fn/Cr ratio were 81.8% and 79.4 % respectively. Moreover, urinary Fn and Fn/Cr ratio had obvious discrepancy among tumor grades and stages（P〈0. 05, P〈0.05）. Otherwise, Sensitivity and specificity of the urinary Fn/Cr were not higher than that of the other urinary tumor markers cited in the literature. Conclusion： Urinary Fn and Fn/Cr ratios have significant diagnostic value in the patients with bladder cancer. Urinary Fn is claimed to be a potential role in the diagnosis and prognosis of bladder cancer. Obvious relationship between urinary Fn and the stages or grades has been noted. Determining urinary Fn values may give an idea about the invasive potential of the tumor and may estimate the prognosis. However,as with the other urinary tumor markers,the test performance was not sufficient to replace cystoscopy. The optimal cut-off was established at 250μg/L for urinary Fn and 62mg/mol for Fn/Cr.