尿膀胱肿瘤抗原在膀胱癌诊断中的临床价值及相关性分析

The clinical significance and influencing factors of urinary bladder tumor antigen in the diagnosis of bladder carcinoma

目的分析尿膀胱肿瘤抗原(BTA)在膀胱癌筛查中的临床应用价值及影响因素。方法回顾性分析76例膀胱癌和42例泌尿系统良性疾病患者的临床资料,采用酶联免疫吸附测定(ELISA)检测尿液BTA浓度和尿脱落细胞阳性表达情况。采用受试者工作特征曲线(ROC)确定截断点、灵敏度、特异度和曲线下面积(AUC),采用秩和检验比较BTA和尿脱落细胞学检查的AUC差异;相关性分析采用Spearman相关分析。结果 BTA检测的最佳截断点为91.74 ng/ml,且AUC明显大于尿脱落细胞学检查(P﹤0.01)。膀胱癌患者尿液中BTA含量明显高于良性疾病组患者(P﹤0.01)。BTA检测的灵敏度为89.47%(68/76),明显高于尿脱落细胞学检查的38.16%(P﹤0.01)。BTA阳性检测结果与血尿浓度、TNM分期、WHO病理组织学分级呈正相关(P﹤0.05),尿脱落细胞学检查结果仅与膀胱癌患者TNM分期呈正相关(P﹤0.05)。结论尿BTA检查灵敏度和特异度较高,可用于膀胱癌早期无创性筛查。

Objective To investigate the clinical significance of urinary bladder tumor antigen(BTA)in the diagnosis of bladder carcinoma and the relationship with pathological characteristics.Method The urinary samples from 76 patients with bladder carcinoma and 42 patients with urological benign disease were retrospectively analyzed,the level of urinary BTA and the urine cytology were detected by enzyme-linked immunosorbent assay(ELISA),receiver operating characteristic(ROC)curve was plotted to determine the critical value,sensitivity,specificity and area under the curve(AUC),meanwhile,rank-sum test was utilized to compare the difference between the AUC of BTA and urine cytology,besides,the correlation was discussed by Spearman analysis.Result The optimal critical value of BTA in diagnosis was 91.74 ng/ml,and the AUC of BTA was larger than that of urine cytology(P<0.01).The BTA level in patients with bladder carcinoma was higher than that in those with urological benign diseases(P<0.01).The sensitivity of BTA was 89.47%(68/76),which was higher than that of urine cytology(38.16%)(P<0.01).Besides,the finding of positive BTA were correlated with hematuria,TNM stages and WHO classifications(P<0.05),But urine cytology was only associated with TNM stages(P<0.05).Conclusion The urinary BTA is of higher sensitivity and specificity,which would be an effective early screening option for bladder carcinoma.