尿核基质蛋白22和细胞角蛋白20mRNA联合监测在膀胱肿瘤复发中的意义

Clinical significance of combined detection with urinary nuclear matrix protein 22 and cytokeratin 20 mRNA in the monitoring of bladder tumor recurrence

目的通过检测尿核基质蛋白22(NMP22)和细胞角蛋白20(CK20)mRNA的表达,探讨联合检测NMP22和CK20mRNA在膀胱肿瘤复发中的临床价值。方法分别采用酶联免疫吸附实验(ELISA)和巢式RT-PCR法检测NMP22和CK20mRNA在46例膀胱肿瘤复发患者(复发组)、66例未复发患者(未复发组)及40例健康志愿者(健康对照组)尿中的表达。结果健康对照组尿中NMP22和CK20mRNA表达均为阴性,复发组尿中NMP22和CK20mRNA的阳性表达率[78.3%(36/46)、80.4%(37/46))]与未复发组[6.1%(4/62)、6.1%(4/62)]及健康对照组比较,差异有统计学意义(P<0.01);未复发组与健康对照组比较,差异无统计学意义(P>0.05)。随肿瘤病理学分级、临床分期的增高,尿NMP22阳性表达率明显上升(P<0.05)。随肿瘤数目的增多,CK20mRNA的阳性表达率明显升高(P<0.05)。检测膀胱肿瘤复发NMP22的敏感度和特异度分别为78.3%、93.9%,CK20mRNA的敏感度和特异度分别为80.4%、93.9%,联合检测二者的敏感度和特异度分别为95.7%、92.4%,联合检测与单一检测相比敏感度差异有统计学意义(P<0.05),特异度差异无统计学意义(P>0.05)。结论 CK20mRNA阳性提示复发可能为多发,尿中NMP22和CK20mRNA联合检测明显提高了临床监测膀胱肿瘤复发的敏感度和特异度。

Objective To detect the expression of urinary nuclear matrix protein 22（NMP22） and cytokeratin 20（CK20） mRNA in the monitoring of bladder tumor recurrence ,and to explore the clinical value of combined detection of urinary NMP22 and CK20 mRNA in the monitoring of bladder tumor recurrence .Methods Enzyme‐linked immunosorbent assay（ELISA） and nested reverse transcriptase polymerase chain reaction（Nested RT‐PCR） were used to detect the expression of NMP22 and CK20 mRNA in the u‐rine of 46 patients with recurrent bladder cancer tumor （recurrent group） ,66 patients without recurrent tumor （no‐recurrent group） and 40 healthy volunteers（control group） respectively .Results The expression of NMP22 and CK20 mRNA in the urine of control group were negative .There was statistically significant difference between the positive expression rate of NMP 22 and CK20 mRNA in the urines of the recurrent group[78 .3% （36/46） ,80 .4% （37/46））] and that of the no‐recurrent group[6 .1% （4/62） , 6 .1% （4/62）] and the control group respectively （P〈0 .01） .There was no statistically significant difference between the no‐recur‐rent group and the control group（P〉0 .05） .The expression level of NMP22 in recurrent tumor increased obviously along with the progression of the pathological grade and clinical classification of tumor （P〈0 .05） .The positive rate of CK20 mRNA expression in the recurrent group increased obviously along with the increase of the tumor number （P〈0 .05） .The sensitivity and specificity of NMP22 for monitoring bladder cancer recurrence were 78 .3% and 93 .9% ,of CK20 mRNA were 80 .4% and 93 .9% .Combined de‐tection of both sensitivity and specificity were 95 .7% and 92 .4% .Statistical significance was observed between combined sensitivi‐ty and that of single detection（P〈0 .05） .No significant difference was observed between combined specificity and that of single de‐tection（P〉0 .05） .Conclusion The positive expression of CK20 mRNA may also indicate tumor multiplicity .Combined detection of NM P22 and CK20 mRNA significantly increases the sensitivity and specificity in clinical detection .