尿沉渣端粒酶逆转录酶检测在膀胱移行细胞癌诊断及术后随访中的意义

Significance of detection of hTERT in urine sediment in diagnosis and follow up of the transitional cell carcinoma of bladder.

目的研究尿沉渣端粒酶逆转录酶（hTERT）检测在膀胱移行细胞癌诊断及术后随访中的临床意义。方法采用逆转录聚合酶链反应（RT-PCR）检测42例膀胱移行细胞癌、40例非膀胱癌患者尿脱落细胞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36例膀胱移行细胞癌术后尿液hTERT mRNA变化与复发的关系。结果42例膀胱移行细胞癌患者中有30例hTERT呈阳性表达；40例非膀胱癌患者中有3例hTERT呈阳性表达。hTERT检测的灵敏度和特异度分别为71．43％和92．50％；G1-G3级肿瘤hTERT检测的灵敏度分别为50．00％、73．68％和90．91％。尿脱落细胞学方法的灵敏度和特异度为19．5％和100％，尿hTERT检测与之相比，灵敏度高，特异度无差异。随访过程中6例患者复发，尿沉渣hTERT检测阳性表达后8-16周，膀胱镜证实膀胱癌复发。结论①尿沉渣hTERT检测灵敏度及特异度较高，可作为膀胱移行细胞癌诊断及鉴别诊断的肿瘤标记物，优于传统的尿脱落细胞学检查。②尿hTERT相对表达量随临床分级及临床分期的升高而增加。③膀胱移行细胞癌患者术后尿hTERT阳性表达可提示复发，在膀胱移行细胞癌患者术后复发的监测中有一定的意义。

Objective To study the clinical significance of urinary hTERT in diagnosis and follow up of transitional cell carcinoma of urinary bladder. Methods Semi-quantitative RT-PCR was used to detected the expression of hTERT mRNA expression in 42 cases with bladder transitional carcinoma and 40 patients without.carcinoma of bladder. Regular urine cytology results were compared with the expression of hTERT. Following-up observision of the changes of hTERT mRNA expression and its relation with recurrency in 36 cases of transitional cell carcinoma of urinary bladder was conducted. Results 30 of 42 cases with bladder transcriptional carcinoma were found positive expression of hTERT, but only 3 in the control group of 40 cases presented the positive expression of hTERT. The o- verall sensitivity and specificity for hTERT were 71.43% and 92.50%. The sensitivities for hTERT were 50.00%, 73.68% and 90.91% respectively in G1-G3 tumor. The urine hTERT expression level significantly increased with the tumor grade and clinical staging. The sensitivity and the specificity of urinary cytology were 19.05% and 100 %. Compared with hTERT, the cytology had lower sensitivity and no difference in specificity. The recurrence of the tumor was found in 6 patients. 8-16 weeks after positive expression of hTERT, cystoscope confirmed recurrence of bladder carcinoma. Conclusions hTERT is a tumor marker of transcriptional carcinoma of bladder, because of its relatively high sensitivity and specificity. Detection of hTERT in urine sediment is superior to traditional cytology. The urine hTERT rate significantly increases with the tumor grade and the clinical stage, hTERT can indicate recurrence of bladder carcinoma, so it is valuable to the monitoring of recurrence of transcriptional cell carcinoma of bladder.