癌性胸腔积液K-ras基因突变检测及临床应用

DETECTION OF K-ras ONCOGENE MUTATION IN MALIGNANT PLEURAL EFFUSION AND ITS POSSIBLE CLINICAL APPLICATION

目的：探讨Ｋ－ｒａｓ 基因突变检测用于癌性胸腔积液的诊断价值。方法：采用ＰＣＲ－ ＳＳＣＰ技术对５８ 例癌性及３０ 例结核性胸腔积液进行Ｋ－ｒａｓ 基因突变分析。结果：结核性胸液未发现突变，癌性胸液有１７ 例突变阳性，突变率２９－３ ％ ，其中腺癌所致胸腔积液突变率为３４－１％ （１４／２１），鳞癌１６－７ ％（２／１２）。１７ 例Ｋ－ｒａｓ 基因突变阳性的胸液中，１４ 例为肉眼血性，明显高于非血性胸液组，Ｐ＜ ０－０５。１８ 例未找到原发病灶的胸液中４４－４％ Ｋ－ ｒａｓ 基因突变阳性。４９ 例患者随访１０ 个月，Ｋ－ｒａｓ 基因突变阳性者死亡率高达８０－０ ％ ，而无Ｋ－ｒａｓ 基因突变者死亡率明显降低，为２６－５ ％ ，Ｐ＜ ０－０５ 。结论：Ｋ－ｒａｓ 基因突变检测是诊断癌性胸腔积液的又一有效手段，在某些情况下显示出特有的优势，并且对预后的判断有一定价值。

To evaluate the diagnostic value of the point mutation of K-ras oncogene in malignant pleural effusion,we detected K-ras codon 12,13 mutations in 58 patients with malignant pleural effusion,30 patients with tuberculous pleurisy by polymerase chain reaciton-single strand comformation polymorphisms(PCR-SSCP).We found that K-ras mutation rates were 29.3%(17/58) in the patients with malignant pleural effusion,none positive case in tuberculous pleurisy.Mutations occured in 14 of 41 cases (34.1%) of adenocarcinoma, 2 of 12 squamous cell carcinoma(16.7%).Among 58 patients with malignant pleural effusion,only 49 patients can be traced during 10 months.The mortality was 80.0%(12/15) in the patients with K-ras mutation, significantly higher than 26.5%(9/34) in the cases with negative K-ras mutation( P <0.05).It suggests that K-ras mutation may be a prognostic mark for the patients with malignant pleural effusion.