【摘要】 目的　用分子生物学检测手段寻求敏感的肺癌诊断新方法。方法　应用多聚合酶链反应 (PCR)及聚合酶链式反应 单链构型多态 (PCR SSCP)银染技术 ,检测 5 6例肺癌和 3 6例肺部良性疾病患者肺泡灌洗液和 (或 )胸水细胞的p5 3、p16及K ras基因的突变情况 ,将检测结果与组织学、脱落细胞形态学诊断结果进行对比分析。结果　肺癌患者肺泡灌洗液和 (或 )胸水脱落细胞形态学检测敏感性为 5 7% ,阴性预计值 (NPV)为 60 % ;p5 3阳性表达的敏感性为 68% ,NPV为 61% ;p16阳性表达的敏感性为 46% ,NPV为 5 2 % ;K ras阳性表达的敏感性为 3 6% ,NPV为 83 % ;p5 3、p16及K ras阳性表达的敏感性为 82 % ,NPV为 74% ;p5 3、p16及K ras分子生物学和脱落细胞形态学联合检测 :敏感性提高至 93 % (P <0 .0 5 ) ,NPV为 87% (P <0 .0 5 )。 2 4例脱落细胞形态学假阴性标本中经分子生物学检测阳性 16例 (67% )。在 5 6例肺癌中 ,其中有 2 2例同时收取肺泡灌洗液细胞和胸水细胞 ,结果为细胞病理学检测敏感性由 5 7%提高到 68% ,细胞病理学检测加分子生物学检测敏感性由 93 %提高到 95 %。结论　脱落细胞癌基因的分子生物学检测可增加脱落细胞形态学检测的敏感性 ,提高脱落细胞形态学的诊断价值更多还原

【Abstract】 Objective To find a new molecular biological method for detection of lung cancer.Methods p53 and K ras mutations,p16 deletion of exfoliated cells in pleural effusion and lavage fluid from 56 cases of lung cancer and 36 cases of other lung diseases were detected by multiple polymerase chain reaction and polymerase chain reaction single strand conformation polymorphism analysis with silver staining method,and compared with the results of histodiagnosis cellular pathobiology.Results Out of 56 lung cancer patients,the exfoliated cells in 32 were positive for cytology:sensitivity was 57%,negative predictive value (NPV) was 60%; The combination of conventional cytology and molecularscreening(p53+p16+K ras) produced a sensitivity value of 93%( P <0.05) with an NPV of 87%( P <0.05).In 24 cases of patients whose cytology of the exfoliated cells were false negative,16 were found p53,p16 or K ras mutation.Conclusion These results suggest that detection of oncogene in the exfoliated cells can increase the sensitivity and diagnostic value of conventional cytology.更多还原