粪脱落细胞诊断大肠癌的探讨

Role of exfoliated epithelial cells in faeces in diagnosis of colorectal carcinoma

目的 探讨粪脱落细胞的提取方法 ,了解粪脱落细胞及其p5 3蛋白的检测对大肠癌诊断的价值。方法 粪脱落细胞学检测 41例大肠癌患者 ,110例非大肠癌患者。 110例中 5 0例为健康者 ,2 9例为慢性肠炎 (包括 10例溃疡性结肠炎 ) ,2 6例为大肠腺瘤 ,5例为胃癌。粪脱落细胞以淘洗法提取 ,并用免疫化学法做粪隐血试验 (faecaloccultbloodtest,FOBT) ,同时采用S P法对 2 7例大肠癌患者的癌组织及粪脱落细胞进行p5 3蛋白检测。结果 脱落细胞学对大肠癌检测的特异性高于粪隐血试验 (P <0 0 5 )。粪脱落细胞及粪隐血试验间的敏感性差异不显著 (P>0 0 5 )。粪脱落细胞p5 3表达阳性率为 37 0 % (10 /2 7) ,与大肠癌组织p5 3检测一致率为 85 2 % (2 3/2 7)。结论 粪脱落细胞检测对大肠癌的诊断具有重要意义 ,而且有望与FOBT序贯进行大肠癌的筛查。粪脱落细胞p5 3蛋白的表达基本反映了癌组织中p5 3突变状况 。

Objective To investigate the significance of colorectal exfoliated cells in faeces and their expression of p53 in the diagnosis of colorectal carcinoma. Methods Exfoliated epithelial cells in faeces were isolated with elutriation and observed in 151 patients, in which 41 patients suffered from colorectal carcinoma confirmed by histopathologic examination and the rest of the patients, including 50 healthy individuals, 29 chronic colitis, 26 colorectal adenomas and 5 gastric carcinomas, had no colonscopic evidence of colorectal cancers and therefore served as controls. Faecal occult blood test (FOBT) was done in all the individuals in this study. Expression of p53 in the exfoliated cells was detected in 27 cases of colorectal carcinoma. Results Exfoliate cytology had higher specificity than FOBT in the diagnosis of colorectal carcinoma (p<0.05). But there was no significant difference in sensitivity for the diagnosis between the two methods. Positive rate of the expression of p53 in the exfoliated cells was 37.04% (10/27). The agreement rate of p53 expression in tumor tissues and exfoliated cells was 85.19% (23/27). Conclusions Exfoliated cytology in faeces has a higher sensitivity and specificity for diagnosis of colorectal carcinoma. Detection of the exfoliated cells combined with FOBT may be suitable for screening of colorectal cancers. p53 expression in the exfoliated cells may be helpful in the diagnosis.