可疑肺癌病人纤支镜检查标本的p53基因突变检测

Detection of p53 gene mutation of bronchoscopic samples in the patients suspected to lung cancer

目的 :探讨纤支镜检查标本的 p5 3基因突变检测用于肺癌早期诊断的可行性。 方法 :采用聚合酶链反应 单链构象多态性分析 (PCR SSCP)银染技术 ,对 35例怀疑为肺癌病人的 85份纤支镜检查标本行 p5 3基因 5～ 8号外显子突变检测。结果 :发现 10例病人有 p5 3基因突变 (2 8 6 % ) ,其中以 6号外显子突变率最高 (17 1% )。在 85份标本中 ,纤支镜后痰、灌洗和刷检标本的p5 3突变率明显高于相应标本的细胞学阳性率 (t=2 416 0 ,P <0 0 5 )。其中以痰的 p5 3突变率最高 (2 7 6 % ) (t=2 0 2 0 0 ,P <0 0 5 ) ,但活检组织的 p5 3突变率明显低于病理学阳性结果 (t=2 330 0 ,P <0 0 5 ) ,而综合分析所有痰、灌洗、刷检和活检标本的细胞学和病理学阳性率则与 p5 3突变率之间无明显差异。虽然纤支镜表现为支气管内新生物时所获标本 ,其 p5 3突变率 (45 5 % )高于表现为支气管狭窄和 /或管口间嵴增宽 ,粘膜炎症 (分别均为 2 5 0 % ) ,但统计学上无差异。值得注意的是 ,3例有p5 3突变的病人纤支镜仅表现为粘膜炎症。结论 :纤支镜检查标本的p5 3基因突变检测对肺癌的诊断价值优于相应标本的肿瘤细胞学检查。单独取用痰标本 ,即可较理想地进行 p5 3突变检测 。

Objective:To ascertain the feasibility of detecting p53 gene mutations for early diagnosis of lung cancer using the samples from fibroptic bronchoscopic examinationMethods:Piont mutations of the exon 5～8 of p53 gene were analysed using silver staining PCRSSCP in 85 bronchoscopic samples of 35 patients suspected to be lung cancer Results:The p53 gene mutations were founded in 10 of 35 patients (286%)The incidence of p53 gene mutations (149%) in samples of sputum, bronchial lavage and brush, especiallyin the sputum(277%) was obviously higher than the cytological positive incidence (29%) In the bronchoscopic biopsy specimens, the incidence of p53 gene mutations(125%) was lower than that of pathologic positive result(500%)However, in view of all the bronchoscopic samples, there was no statisticallydifference between cytopathologic positive results(118%) and the incidence of p53 gene mutations(141%)Although the incidence of p53 mutations was higher in the samples from the patients bronchoscopically manifested as neoplasm compared with other manifestations, the difference was stafistically not significantIt is valuable to notice that 3 patients with p53 gene mutation merely presented as bronchial inflamation in bronchoscopyConclutions:The present results indicate that the value of detecting p53 gene mutation using the bronchoscopic samples for the diagnosis of lung cancer was more superior to cytologic examinationThe detection of p53 gene mutations in postbronchoscopic sputum was easy and effective, may be used as a valuable method for early diagnosis of lung cancer