细胞核仁组成区嗜银蛋白检测对良恶性胸腔积液的鉴别诊断价值探讨

Study on diagnostic value of analyzing argyrophilic nucleolar organizer regions in benign and malignant pleural effusions

目的探讨核仁组成区嗜银蛋白（ＡｇＮＯＲ）检测在良性胸腔积液间皮细胞和恶性胸腔积液癌细胞鉴别诊断中的价值。方法对５０例恶性、３０例良性胸腔积液患者的胸腔积液细胞涂片行ＡｇＮＯＲ染色，观察良性胸腔积液间皮细胞和恶性胸腔积液癌细胞核内的ＡｇＮＯＲ数目和形态。另观察６例临床疑诊恶性胸腔积液而常规脱落细胞检查阴性者胸腔积液细胞核内的ＡｇＮＯＲ数目和形态。结果恶性组癌细胞平均每核ＡｇＮＯＲ数显著高于良性组间皮细胞；恶性组癌细胞核内ＡｇＮＯＲ形态以弥散型为主，而良性组间皮细胞核内ＡｇＮＯＲ形态以核仁型为主。６例疑诊恶性胸腔积液患者胸腔积液细胞核内ＡｇＮＯＲ数目和形态，４例具有恶性特征，２例在良性范围，为组织病理所证实。结论ＡｇＮＯＲ检测作为胸腔积液细胞学检查的一项新指标。

Objective To evaluate the diagnostic value of argyrophilic nucleolar organizer regions (AgNOR) measurement in benign and malignant pleural effusions,Methods Pleural effusions from 50 patients with proven malignant disease, 30 patients with benign disease were studied using the one step silver staining method. Six cytologically atypical samples were also included in this study. Results The mean AgNOR count in malignant cells was significantly higher than that in benign mesothelial cells (7.6± 1.4 vs 2.3±0.7, P <0.01). The morphological features of AgNOR in malignant cells were mainly of diffuse type (80%), while in benign mesothelial cells, mainly of nucleolar type (90%). Among the six cytologically atypical samples, four were in the malignant range, two were in the benign limits, and these were proved by histopathology. Conclusion AgNOR study may be useful in differential diagnosis of benign and malignant pleural effusions.