DNA倍体及相关基因蛋白含量的检测在脱落细胞学诊断中的意义

THE SIGNIFICANCE OF DNA-PLOID,TELOMERASE,p53 AND p21 EXPRESSION ON EXFOLIATIVE CYTOLOGIC DIAGNOSIS

目的研究胸腹水中脱落细胞DNA、端粒酶、p53及p21基因蛋白产物的表达,为临床良恶性肿瘤的诊断及鉴别诊断提供有价值的参考依据,与脱落细胞学诊断相结合,提高恶性肿瘤诊断的阳性率。方法对胸腹水中的脱落细胞进行细胞学检查,利用流式细胞术测定93例胸腹水中DNA倍体、端粒酶、p53、p21基因蛋白产物。结果经细胞学诊断为癌或可疑癌41例(44.1%),其中DNA异倍体32例,端粒酶表达阳性39例,p53表达阳性39例,p21表达阳性35例。在细胞学诊断阴性的52例中,DNA异倍体8例,端粒酶表达阳性20例,p53表达阳性17例,p21表达阳性17例。以上方法联合检测,阳性63例(阳性率为67.7%)。结论采用脱落细胞学与流式DNA倍体、端粒酶和基因蛋白定量检测相结合的办法进行诊断,阳性率高于单纯的细胞学检查。这对于临床中减少漏诊将有重要的参考价值。

Objective To explore valubale references for diagnosis of benign and malignant tumor by detecting DNA,telomerase,p53 and p21 gene protein expression of exfoliated cells in pleural and peritoneal fluid, and to improve the diagnostic positive rate of malignant tumor by binding with exfoliative cytologic diagnosis. Methods Ninety-three cases of exfoliated cells were examined using pathological method. DNA-ploid, telomerase, p53 and p21 gene protein expression of the same specimen were examined by flow cytometer. Results Forty-one cases were diagnosed as cancer or doubtful cancer, in which 32 cases were heteroploid, 39 cases were telomerase positive,39 cases were p53 positive and 35 cases were p21 positive. In 52 negative cases,8 cases were heteroploid,20 cases were telomerase positive,17 cases were p53 positive and 17 cases were p21 positive. 63 cases were positive by combining the two methods. Conclusion Diagnostic positive rate is higher by binding exfoliative cytological examination, flow cytometer DNA-ploid and gene protein quantitative examineation than cytological examination alone. It is valuable for reducing missed diagnosis to combine the two methods.