生存素基因联合细胞角蛋白19片段抗原及癌胚抗原检测对肺癌引起胸腔积液的诊断意义

Diagnostic value of survivin gene combined with cytokeratin 19 fragments antiogen 21-1 and carcinoembryonic antigen detection in pleural effusions caused by lung cancer

目的:探讨生存素(survivin)基因联合细胞角蛋白19片段抗原(CYFRA21-1)及癌胚抗原(CEA)检测对肺癌的诊断意义。方法:用反转录聚合酶链反应(RT-PCR)法检测65例肺癌和58例结核性胸膜炎患者胸腔积液中survivin mRNA表达,并行胸腔积液细胞学检测;同时用放射免疫分析法检测胸腔积液CEA、CYFRA21-1。结果:肺癌组胸腔积液survivin mRNA阳性率为80.0%,高于首次细胞学检查的阳性率(47.6%),结核性胸腔积液组survivin mRNA无表达(P<0.01)。胸腔积液survivin mRNA检测诊断肺癌胸膜转移的特异性(94.8%)高于CEA及CYFRA21-1(77.6%和75.8%);survivin mRNA检测的敏感性(80.0%)高于CEA(50.8%)(P<0.05),但与CYFRA21-1(78.5%)相似(P>0.05)。结论:survivin mRNA是诊断肺癌胸膜转移特异性较高的分子标志物,联合CEA及CYFRA21-1检测对鉴别肺癌性和结核性胸腔积液的鉴别诊断有重要意义。

Objective：To explore the diagnostic value of detection of survivin combined with cytokeratin 19 fragments antigen,21-1（CYFRA21-1）and carcinoembryonic antigen（CEA）in pleural effusions caused by lung cancer.Methods：Reverse transcription-polymerase chain reaction（RT-PCR）was performed to detect the survivin mRNA expression in pleural effusion of 65 patients caused by lung cancer and 58 patients caused by tuberculous pleurisy,and the cytological examinations in these samples were determined.The detections of CEA and CYERA21-1 were performed by radioimmunoassay.Results：The positive rate of survivin mRNA was 80.0% in pleural effusions of lung cancer,which was significantly higher than the positive rate of initial cytological examination（47.6%）.And there was no survivin mRNA expression in tuberculous pleural effusions（P0.01）.The specificity of survivin mRNA in pleural effusions caused by lung cancer（94.7%）was higher than the specificity of CEA and CYFRA21-1（77.6% and 75.8%,respectively）（P0.05）.The sensitivity of survivin mRNA detection（80.0%）was significantly higher than CEA detection（50.8%）（P0.05）,but there was no significant difference between survivin mRNA and CYFRA21-1 detection（P0.05）.Conclusions：Survivin mRNA was a specific molecular marker for diagnosis of pleural metastasis of lung cancer,which had significant implications for diagnosis and differential diagnosis of lung cancer and tuberculous pleurisy combined with CYFRA21-1 and CEA.