尿脱落细胞端粒酶催化亚基mRNA检测在膀胱癌诊断和监测复发中的意义

Detection of hTERT mRNA expression in urine exfoliated cells and its significance in diagnosing bladder cancer and monitoring recurrence

目的探讨尿脱落细胞端粒酶催化亚基(human telomerase reverse transcriptase,hTERT)mRNA检测在膀胱癌早期诊断和监测复发中的应用价值。方法采用逆转录聚合酶链反应(reverse transcriptase PCR,RT-PCR)检测42例膀胱癌、38例膀胱良性疾病患者和12例健康体检者晨尿中脱落细胞hTERT mRNA的表达,并与尿脱落细胞学检查结果比较;随访观察其中37例膀胱癌术后尿液hTERT mRNA变化与复发的关系。结果hTERT检测膀胱癌的敏感性为97.62%,显著高于尿脱落细胞学检测的61.9%(P<0.05);特异性为96%,与尿脱落细胞学检测98%无明显差异(P>0.05);膀胱癌患者术前hTERT mR-NA表达强度明显高于膀胱良性疾病患者和对照组(P<0.05);且随肿瘤恶性程度的增加逐渐升高,G1、G2、G3(WHO分级)患者hTERTmRNA表达强度分别为0.63±0.14、0.75±0.16、0.87±0.20。结论尿脱落细胞hTERT mRNA检测具有高度敏感和特异性,对膀胱癌早期诊断、疗效评估和术后监测复发具有重要的临床应用价值。

Objective To evaluate the significance of detection of human telomerase reverse transcriptase （hTERT） mRNA expression in urine exfoliated cells for the diagnosis and postoperative monitoring of bladder cancer recurrence. Methods The middle and later urine voided firstly in the morning were collected from 42 patients with bladder cancer, 38 patients with bladder benign lesions and 12 healthy controls. RT-PCR was performed for the hTERT mRNA in urine exfoliated cells. The cytologic analysis was carried out simultaneously, and the two detection results were compared. 37 postoperative patients among them were followed up to study the relations between hTERT mRNA expression with recurrence. Results The detection of hTERT mRNA expression in urine exfoliated cells had higher sensitivity （97.62%） than that of cytologic analysis （61.9 %） （P〈0.05）, and their specificity was not significantly different. The expression intensity of hTERT mRNA in urine exfoliated cells from preoperative patients with bladder cancer were greater than that from patients with bladder benign lesions and healthy controls （P 〈0.05）, and the expression intensity in higher grade bladder cancer was greater compared with that in lower grade cancer（P〈0.05）. The expression intensity of hTERT mRNA in urine exfoliated cells from patients with bladder cancer at G1, G2 and G3 were 0. 635±0.14, 0.75 5±0.16 and 0.87±0.20. Conclusion hTERT mRNA detection by RT-PCR has higher sensitivity and specificity, and has potential value for the early diagnosis and postoperative monitoring of bladder cancer recurrence.