【摘要】 目的探讨核基质蛋白22(nuclear matrix protein 22,NMP 22)在尿路上皮肿瘤中的诊断价值及影响检测结果的相关因素。方法收集337例术前怀疑为尿路上皮肿瘤患者的资料,术前均使用尿NMP22诊断试剂盒(BladderChek)行NMP22检测,以术后诊断或病理结果作为诊断金标准。将检测结果按研究目的分组并分析,卡方检验比较率的差异,使用非条件Logistic回归分析判断影响检测结果的因素。结果 NMP22的总体灵敏度为37.0%,特异度75.4%,假阳性率24.6%,假阴性率63.0%,阳性预测值58.3%,阴性预测值56.4%。解剖部位分层提示NMP22在上尿路组和下尿路组的灵敏度无统计学差异。分期分层提示NMP22在浸润性尿路上皮肿瘤组的灵敏度高于非浸润性组。分级分层提示随着尿路上皮肿瘤恶性程度的增加,NMP22的灵敏度有递增趋势。相关干扰因素分析提示血尿、尿路感染对NMP22检测结果存在影响,且为正相关。结论 NMP22检测具有非侵入性、快速诊断、误差小等特点;NMP22在高分期、高分级尿路上皮肿瘤患者术后随访过程中的应用价值要高于低分期、低分级组;血尿和尿路感染是影响检测结果的主要因素,在排除上述因素的干扰后,NMP22的特异性接近于尿细胞学;NMP22不仅适用于下尿路尿路上皮肿瘤的诊断,上尿路同样适用;NMP22阳性预示患者处于高危组可能性较大。更多还原

【Abstract】 Objective To study the diagnostic efficacy of the NMP22BladderChek?test and determine the interference on results of test in the detection of urothelial carcinoma. Methods We evaluated 337 voided urinary specimens of patients with suspicion of urothelial carcinoma.All voided urine samples were evaluated by the BladderChek?test,the results were divided into groups by anatomical region,stage,grade and compared to the sensitivity of different groups.Non-conditional Logistic regression was used to analyze the interference factors on the results of NMP22. ResultsThe total sensitivity and specificity of the NMP22 were 37.0% and 75.4% respectively.The false positive rate and false negative rate were 24.6%and 63.0%respectively.The positive predictive value and negative predictive value were 58.3% and 56.4% respectively.The study showed that the sensitivity between upper and lower urinary tract was not statistically significant(P>0.05).The sensitivity of NMP22 in papillary urothelial neoplasms,papillary urothelial neoplasms of low malignant potential,low grade and high grade urothelial carcinoma were 5.9%,18.8%,28.6%,58.4%respectively.The sensitivity of NMP22 in non-invasive group and invasive group were 23.7% and55.1% respectively.Pathology,hematuria and urinary tract infection impacted the results of NMP22 test. Conclusions The total sensitivity and specificity of NMP22 were not high enough to replace the endoscopy and biopsy,but the specificity of NMP22 was 94%after excluding the interference factors as hematuria and infection.It′s advantage included non-invasive,point of care,and economical.When following up,the diagnostic efficacy in high grade or high stage group was higher than low grade or low stage group′s.Also,NMP22 could be used for detecting urothelial carcinoma of upper urinary tract.更多还原