ClinicalExperience·临床经验胸水脱落细胞DNA含量及VEGF,p53和CEA表达在良恶性胸腔积液鉴别中的意义周箴1,陈岗2,宣学金2,张俭2(1.上海市肺部肿瘤临床医学中心,上海200030;2.上海交通大学附属胸科医院病理科,上海200030)[摘要]目的:探讨检测胸水细胞的DNA倍体以及VEGF、p53、CEA表达鉴别良恶性胸腔积液的价值。方法:73例胸腔积液患者,良性组13例,恶性组60例。图像细胞光度技术(imagecytometry,ICM)进行DNA含量检测,免疫组化Envision法检测VEGF、p53、CEA。结果:良性胸水DNA异倍体率仅占23.1%。恶性胸水的异倍体率占77.8%,两者有统计学差异(P=0.001)。良性胸腔积液患者VEGF、p53、CEA表达率分别为12.5%、0、0。恶性胸腔积液VEGF、p53、CEA表达率分别为17.5%,17.5%和68.4%,与良恶性胸腔积液中CEA的表达相比有统计学差异(P<0.001),VEGF和p53的表达无显著差异(P=0.722,P=0.198)。经DNA倍体联合VEGF、p53、CEA检测,敏感率可达90.4%,特异度87.5%,符合率90%。结论:ICM检测胸水细胞的DNA倍体联合VEGF、p53、CEA表达值得进一步探讨,有可能成为鉴别良恶性胸腔积液的又一方法。[关键词]肺肿瘤;胸腔积液,恶性;DNA;基因表达;免疫组织化学;诊断,鉴别[中图分类号]R734.2;R730.43[文献标识码]A[文章编号]100027431(2007)0220155203ClinicalsignificanceofDNAcontentandVEGF,p53andCEAexpressionsinthedifferentialdiagnosisofmalig2nantandbenignpleuraleffusionsZHOUZhen1,CHENGang2,XUANXue2jin2,ZHANGJian2(1.ShanghaiLungTumorClinicalMedicalCenter,Shanghai200030,China;2.DepartmentofPathology,ShanghaiChestHospitalofJiaotongUniversity,Shanghai200030,China)[ABSTRACT]Objective:ToinvestigatewhethernuclearDNAcontentandvascularendothelialgrowthfactor(VEGF),p53andcarcinoembryonicantigen(CEA)expressionshadapotentialvalueindifferentialdiagnosisofmalignantandbenignpleuraleffusions.Methods:Seventy2threepatientswithunilateralpleuraleffusionweredividedinto2groups:benigngroup(n=13)andmalignantgroup(n=60).TheDNAcontentwasmeasuredbytheimagecytometry(ICM)andthelevelofVEGF,p53andCEAexpressionswerede2tectedbyimmunohistochemicalEnvisionmethod.Results:Theratesofaneuploidinbenignandmalignantpleuralfluidswere23.1%and77.8%,respectively.Thedifferencebetweenthebenignandmalignantpleuraleffusionswassignificant(P<0.001).Immunohis2tochemicalstainingshowedthatthepositiveratesoftheVEGF,p53,andCEAinbenignpleuralfluidwere12.5%,0,and0;inma2lignantpleura1fluidwere17.5%,17.5%,and68.4%,respectively.ThedifferenceinCEAbetweenthebenignandmalignantpleu2raleffusionwassignificant(P<0.001).TheexpressionofVEGFandp53hadnostatisticallydifferencebetweenthebenignandmalig2nantpleuraleffusions(P=0.722,P=0.198).CombineddetectionofDNAcontent,VEGF,p53,andCEAachieved90.4%sensi2tivity,87.5%specificity,and90%consistentrateindiagnosisofmalignantpleuraleffusion.Conclusion:CombineddetectionofDNAcontent,VEGF,p53,andCEAisworthyoffurtherinvestigation.Ithasthepotentialtobecomeaneffectivemethodindifferentialdiag2nosisofmalignantandbenignpleuraleffusions.[KEYWORDS]Lungneoplasms;Pleuraleffusion,malignant;DNA;Geneexpression;lmmunohistochemistry;Diagnosis,differential[Tumor,2007,27(2):1552157,161][作者简介]周箴(19652),女(汉族),副主任医师Correspondenceto:CHENGang(陈岗)Tel:021262821990290616E2mail:chengang888@online.sh.cn胸水是临床上常见的体征,可有多种原因引起,寻找鉴别良恶性胸水的有效方法,具有重要的临床诊断意义。图像细胞光度技术(imagecytometry,ICM)可较客观地通过检测胸水细胞的DNA倍体来判断其良恶性[1]。随着分子生物学技术的发展,对胸水的多种肿瘤标志物的检测,如CEA、VEGF、p53也有助于胸水良恶性的鉴别诊断。1材料与方法1.1材料选自2004年2月-2005年4月本院收住的胸腔积液患者73例...
