支气管灌洗液Survivin基因检测在肺癌诊断中的价值

Diagnostic Value of Expression of Survivin in Bronchial Lavage Fluid of Lung Cancer

目的探讨支气管灌洗液（BLF）标本SurvivinmRNA检测在肺癌尤其是周围型肺癌诊断中的可行性及应用价值。方法应用逆转录．聚合酶链反应（RT—PCR）方法，分别检测124例肺癌、103例支气管肺部良性疾病患者BLF标本SurvivinmRNA表达情况，并与BLF标本细胞病理学等结果相比较。结果BLF标本SurvivinmRNA表达阳性率肺癌患者45．2％（56／124），显著高于支气管肺部良性疾病患者18.4％（19／103），差异有统计学意义（x^2=18．150，P=0．000）。BLF标本SurvivinmRNA相对表达量与肺癌病理类型、分化程度均相关（均P〈0．05）；而与肺癌患者的性别、年龄、抽烟史、肿瘤的部位、大小、淋巴结转移、远处转移、临床分期及中心型肺癌患者BLF方式之间均无明显相关（均P〉0．05）。BLF标本检测SurvivinmRNA诊断肺癌的敏感性、特异性分别为45．2％（56／124）和81．6％（84／103），诊断周围型肺癌的敏感性、特异性分别为35．9％（14／39）和85．4％（88／103）。BLF标本检测SurvivinmRNA表达联合细胞病理学检查阳性率为57．5％（65／113），显著高于单独检测SurvivinmRNA阳性率43．4％（49／113）或细胞病理学阳性率23．9％（27／113），差异均有统计学意义（x^2=4．531，26．472，P=O．033，0．000）。结论BLF标本SurvivinmRNA可能成为肺癌诊断有价值的肿瘤标志物之一，为肺癌尤其是周围型肺癌早期诊断提供帮助，BLF标本获取方式不影响SurvivinmRNA表达检测结果。

Objective To explore the feasibility and value of detecting survivin messenger RNA in BLF specimens as tumor makers for earlier diagnosis of lung cancer, especially peripheral lung cancer. Methods Specimens of BLF were form 124 cases suffering from lung cancer and 103 cases suffering from pulmonary benign diseases respectively. The expression of mRNA of survivin in specimens was detected with the method of reverse polymerase chain reaction （RT-PCR）, and compared with the cytopathological examinations. Results The positive rate of survivin mRNA in BLF of lung cancer 45.2% （56/124） was sharply higher than that 18.4% （19/103） of pulmonary benign diseases （ x^ 2=18.150, P =0.000）. There were correlation between survivin mRNA expression and histopathological subtype, differentiation （all P 〈0.05）, while there were no relationships between survivin mRNA expression and sex, age and smoking of patients, and site, size, lymph node metastases, distant metastasis and clinical stages of lung cancer, and different bronchial lavage sequences （all P 〉0.05）. By detecting survivin mRNA, the sensibility and specificity of the diagnosis for lung cancer were respectively ： 45.2%, 81.6%, for peripheral lung cancer were respectively ： 35.9%, 85.4%. There were significant difference between the positive rate （57.5%） of survivin mRNA combined with cytopathological examination and that （43.4%） of survivin mRNA, that （23.9%） of cytopathological examination in BLF specimens （ x^ 2=4.531, 26.472; P =0.033, 0.000）. Conclusions Survivin mRNA in BLF might be used as the specific molecular marker for diagnosis of lung cancer, especially of peripheral lung cancer. The outcome of expression of survivin mRNA doesn＇t be affected by the different bronchial lavage sequences.