【作者】 孙健；

【导师】 侯建全；

【作者基本信息】 苏州大学 ， 泌尿外科， 2008， 硕士

【摘要】 【目的】研究膀胱移行细胞癌(BTCC)患者术前和术后尿脱落细胞中survivin mRNA的表达,探讨其与BTCC病理分级和临床分期的相关性,以及与术后复发的关系。【方法】(1)采用实时荧光定量PCR(FQ-PCR)法对10例健康志愿者(正常对照组)和18例初发BTCC患者术前、术后一周、术后一月、术后半年尿脱落细胞中survivin mRNA的表达进行检测。BTCC患者按病理分级和临床分期进行分组,对各组间表达差异进行统计学分析。(2)用FQ-PCR法检测30例初发BTCC患者术后半年尿脱落细胞中survivin mRNA的表达,定期随访至15月,对术后复发者再次手术前检测其尿脱落细胞中survivin mRNA的表达。【结果】(1)在BTCC患者术前尿脱落细胞中survivin mRNA高表达。按病理级别分组:尿路上皮癌Ⅰ级患者(6例)survivin mRNA相对拷贝数为55.95±3.70,Ⅱ级(7例)为80.50±4.29,Ⅲ级(5例)为151.57±11.94,与正常对照组(13.12±2.25)相比均有统计学差异(P<0.05),并且各病理分级组间survivin mRNA表达也有统计学差异(P<0.05);按临床分期分组:非肌层浸润组(12例)survivin mRNA相对拷贝数为78.64±34.10,肌层浸润组(6例)为130.73±36.93,与正常对照组相比有统计学差异(P<0.05),不同临床分期组间survivin mRNA表达也有统计学差异(P<0.05)。(2)18例BTCC患者术前尿脱落细胞中survivin mRNA的相对拷贝数为96.01±42.33,与正常对照组有统计学差异(P<0.05);术后一周的相对拷贝数为25.30±1.51,较术前显著下降(P<0.05);术后一月、术后半年的相对拷贝数均明显下降,分别为13.20±1.49和13.90±1.36,与术后一周相比有统计学差异(P<0.05),但与正常对照组相比无统计学差异(P>0.05)。(3)在18例BTCC患者中,一例患者术后半年尿脱落细胞中survivin mRNA相对拷贝数较同期患者明显升高达42.55,术后7.5月经膀胱镜和影像学检查证实复发。(4)在随访的30例BTCC患者中,未复发组术后半年尿脱落细胞中survivin mRNA相对拷贝数为11.97±3.08,术后15月为12.87±2.53,二者前后无统计学差异(P>0.05);复发组术后半年相对拷贝数为14.08±0.50,复发后再次手术前则明显升高达97.83±27.47,二者相比有统计学差异(P<0.05)。【结论】(1)在BTCC患者术前尿脱落细胞中survivin mRNA高表达,其表达量与肿瘤的病理分级和临床分期正相关。因此,尿脱落细胞中survivin mRNA的检测可以作为辅助诊断BTCC的方法之一,并且其表达水平的高低可以评估肿瘤的恶性程度。(2)在BTCC患者手术前后尿脱落细胞中survivin mRNA的表达呈现由高到低的变化,而术后复发的患者尿survivin mRNA的表达又显著提高。因此,检测尿脱落细胞中survivin mRNA的表达不仅可用于诊断初发的BTCC,还可作为术后监测肿瘤复发的一个无创伤性早期诊断的标志物。更多还原

【Abstract】 【Objective】In this study the expression of survivin mRNA in exfoliated cells in preoperative and postoperative urine of patients with BTCC was analysized to investigate the correlation between the expression of survivin mRNA and pathological grades or clinical stages and the correlation between the expression and relapse.【Methods】(1) 10 healthy volunteers were classified to normal control group. Real-time fluorescent quantitation polymerase chain reaction (FQ-PCR) was used to detect the expression of survivin mRNA in exfoliated cells in urine of 18 patients with initial BTCC and the uric samples were gathered before operation、one week after operation、one month after operation and six months after operation. Expression variance was analysized according to pathological grades and clinical stages. (2) By the same method, the expression of survivin mRNA in exfoliated cells in urine of 30 patients with initial BTCC six months after operation was detected, then these patients were followed up by 15 months. The expression of survivin mRNA in exfoliated cells in urine of the recurring patients before they were re-operated was detected.【Results】(1) Survivin mRNA was expressed significantly in exfoliated cells in urine of the preoperative patients with BTCC. The relative copies varied according to the different pathological grades (gradeⅠ: 55.95±3.70, gradeⅡ: 80.50±4.29 and gradeⅢ: 151.57±11.94) in the experimental group, which was markedly higher than that of the control group (13.12±2.25) (P<0.05). The relative copies also varied according to the different clinical stages (muscle noninvasived bladder cancer: 78.64±34.10 and muscle invasived bladder cancer: 130.73±36.93) in the experimental group, which was significantly higher than that of the control group (P<0.05). (2) The relative copies of survivin mRNA in the preoperative patients was 96.01±42.33,which was significantly higher than that of the patients one week after operation (25.30±1.51) (P<0.05), and there was no significance between patients a month (13.20±1.49) or six months (13.90±1.36) after operation and the control group (P>0.05), but which was significantly lower than that of the patients one week after operation (P<0.05). (3) In 18 patients with BTCC, the expression of survivin mRNA in urine of one case six months after operation (42.55) was significantly higher than those of others, which was proved recurring by cystoscopy and imageology seven months and a half after operation. (4) In the 30 follow-up patients, the relative copies of survivin mRNA in six months and 15 months after operation of the non-recurring group were 11.97±3.08 and 12.87±2.53 respectively, However, the relative copies of survivin mRNA in six months after operation and pre-reoperation of the recurring group were 14.08±0.50 and 97.83±27.47 respectively. In the recurring group, the expression of survivin mRNA after recurrence was markedly higher than that before recurrence (P<0.05), while there was no significant difference in the non-recurring group (P>0.05).【Conclusion】(1) Survivin mRNA was expressed significantly in exfoliated cells in urine of the preoperative patients with BTCC. There was significant correlation between the pathological grades or the clinical stages and the expression quantity. Detecting survivin mRNA in the urine can be used to diagnose BTCC and to judge the malignancy of BTCC. (2) The expression of survivin mRNA in exfoliated cells in the preoperative and postoperative urine of the patients with BTCC presents a process from high to low, however the expression of survivin mRNA was higher again in recurring patients. Detecting survivin mRNA in urine not only can be used to diagnose initial BTCC, but also be used to monitor recurrence after operation. It’s possible to be an early-diagnostic marker forecasting recurrence.更多还原