膀胱移行细胞癌尿CYFRA21-1检测的临床意义

Clinical value of detecting urinary CYFRA21-1 in bladder transitional cell carcinoma

目的:探讨尿可溶性细胞角蛋白19片段(CYFRA21-1)诊断膀胱移行细胞癌价值。方法:用ELISA方法检测了35例膀胱移行细胞癌(Ⅰ组),18例泌尿系其它疾病(Ⅱ组),10例非泌尿系疾病患者(Ⅲ组)尿中CYFRA21-1的含量,同时用酶免疫法行尿CEA检测。膀胱移行细胞癌常规行尿细胞学检查。结果:Ⅰ组、Ⅱ组、Ⅲ组尿CYFRA21-1值分别为(7.65±3.75)ng/ml、(2.03±0.71)ng/ml和(1.56±0.95)ng/ml。Ⅰ组与Ⅱ组、Ⅲ组比较均有统计学意义(P<0.001)。尿CYFRA21-1的含量与膀胱移行细胞癌的分级、分期呈正相关。当尿CYFRA21-1取3.5ng/ml为诊断参考值时,其诊断膀胱移行细胞癌的敏感性为85.7%,特异性92.8%,阳性预测值94%,阴性预测值为83.9%。尿CYFRA21-1诊断膀胱移行细胞癌明显优于尿CEA(敏感性57.1%)和尿细胞学(敏感性42.9%)。结论:尿CYFRA21-1是膀胱移行细胞癌的理想瘤标,对诊断膀胱癌有重要价值,对浅表性、低级肿瘤的诊断更有优势。

Objective:To evaluate the clinical value of detecting urine soluble cytokeratin19fragment (CYFRA21-1)in diagnosing bladder transitional cell carcinoma.Methods:The level of CYFRA21-1was investigated with enzyme linked immunosorbent assay(ELISA)in the urine of63pa-tients,including35cases with bladder transitional cell carcinoma (groupⅠ),18with other urological pathological conditions(groupⅡ)and10free of urothelial disease(groupⅢ).Urinary CEA was also detected with enzyme immunoassay(EIA)in all patients.Cytopathology was conducted in bladder tran-sitional cell carcinoma.Results:Urinary CYFRA21-1was(7.65±3.75)ng /ml in groupⅠ,(2.03±0.71)ng /ml in groupⅡand(1.56±0.95)ng /ml in groupⅢ,revealing that it was highly significant in groupⅠcompared with the other2groups(P<0.001).The levels of urinary CYFRA21-1were positively correlat-ed to pathological grades and clinical stages.A3.5ng /ml cut-off value of CYFRA21-1yielded a sensi-tivity of85.7%,specificity92.8%,positive predictive value94%,and negative predictive value83.9%.Diagnosis of bladder transitional cell carcinoma on the base of urinary CYFRA21-1level was superior to that by urinary CEA(sensitivity57.1%)and by cytopathology(sensitivity42.9%).Conclusions:Uri-nary CYFRA21-1is a useful tumor marker of bladder transitional cell carcinoma with great value in diagnosing bladder cancer and is much better in the diagnosis of superficial and low-grade cancer.