尿液无创联合检测在膀胱癌早期诊断中的意义

发布时间：2018-09-03 11:57

【摘要】：目的讨论尿脱落细胞吖啶橙染色法(AO-F)、荧光原位杂交染色(FISH)以及膀胱肿瘤抗原(BTA)单独或联合检测在膀胱尿路上皮癌诊断中的意义。为早期无创诊断膀胱癌提供理论依据。方法1.收集2016年3月-2016年11月就诊于天津医科大学第二医院泌尿外科的膀胱患者82名。泌尿系统良性疾病患者27名纳入对照组。2.收集患者尿液样本并对其分组编号。分别对这些尿液样本进行尿脱落细胞吖啶橙染色法(AO-F)检测、膀胱肿瘤抗原(BTA)检测及荧光原位杂交(FISH)检测。3.分析AO-F、FISH、BTA单独检测在膀胱癌中的诊断意义及病理分级和分期的相关性。4.讨论三种检查手段联合检测在膀胱癌诊断中的意义,包括串联检测和并联检测,使用SPSS18.0绘制受试者工作曲线(ROC),通过曲线下面积(AUROC)对比各种组合在膀胱癌检测中的诊断价值。结果1.AO-F、BTA、FISH三种方法单独检查膀胱癌,敏感性依次为62.2%、69.5%、74.4%,特异性分别为92.6%、77.8%、89.9%。其中FISH敏感性最高,AO-F特异性最高。分析三种检查方法的曲线下面积(AUROC),三者分别为0.774,0.736和0.816,差异有统计学意义,可见FISH的诊断价值最大。2.在低分期和分级的肿瘤中,AO-F的敏感性明显低于高分期和高级别的肿瘤,差异有统计学意义。3.通过对三种方法联合检测膀胱癌的结果分析,将联合检测分为串联和并联两种情况:联合检查中,各项检查结果同时阳性判定总的结果阳性既为串联,联合检查中若至少有一种检测阳性则判定总的结果阳性即为并联。各种串联组合的特异性均为100%,所有串联检查中,BTA串联FISH检查为敏感性最高的组合,达73.2%,根据计算AUROC,可见AO-F并联FISH检查对膀胱癌的诊断价值最大。结论1.本实验尿液标本易收集,可行性高2.AO-F、BTA、FISH检查对膀胱癌的诊断具有临床意义。3.以上三种检查单独检测膀胱癌时,FISH的诊断价值最大。4.AO-F检查敏感性与肿瘤的临床分期和病理分级呈正相关。5.在以上三种检查方法联合检查的各种组合中,AO-F并联FISH检查对膀胱癌的诊断价值最大,故建议对就诊患者行AO-F和FISH检查,能够降低膀胱镜检查的使用频率。
[Abstract]:Objective to evaluate the diagnostic value of acridine orange staining (AO-F), fluorescence in situ hybridization (Fish) and bladder tumor antigen (BTA) in the diagnosis of bladder epithelial carcinoma. To provide theoretical basis for early non-invasive diagnosis of bladder cancer. Method 1. A total of 82 urinary bladder patients from March 2016 to November 2016 in the second Hospital of Tianjin Medical University were collected. 27 patients with benign urinary system diseases were included in the control group. 2. 2. Collect urine samples from patients and group them. The urine samples were detected by acridine orange staining (AO-F), bladder tumor antigen (BTA) and fluorescence in situ hybridization (FISH). To analyze the diagnostic significance of AO-F,FISH,BTA alone in bladder cancer and the correlation between pathological grade and stage. 4. This paper discusses the significance of combined detection of three methods in the diagnosis of bladder cancer, including series detection and parallel detection. The diagnostic value of (ROC), in bladder cancer detection is compared by using SPSS18.0 to draw the operating curve of subjects by area (AUROC) under the curve. Results 1.The sensitivity of AO-FTA-FISH alone was 62.2 and 69.5%, and the specificity was 92.6 and 77.8% respectively. The sensitivity of FISH was the highest and the specificity of AO-F was the highest. The area under the curve of the three methods was 0.7740.736 and 0.816, respectively. The difference was statistically significant, showing that the diagnostic value of FISH was the greatest. 2. The sensitivity of AO-F in low-grade and low-grade tumors was significantly lower than that in high-grade and high-grade tumors, and the difference was statistically significant. Through the analysis of the results of combined detection of bladder cancer by three methods, the combined detection was divided into series and parallel cases: in the joint examination, the positive results were determined to be in series at the same time. If there is at least one positive test in the joint examination, the total positive result is determined to be parallel. The specificity of all series combinations was 100 and the sensitivity of BTA-series FISH was the highest (73.2%). AO-F parallel FISH was the most valuable in the diagnosis of bladder cancer according to the calculation of AUROC,. Conclusion 1. The urine samples of this experiment are easy to collect, and the feasibility is high. 2. AO-FU BTA-FISH is of clinical significance in the diagnosis of bladder cancer. The diagnostic value of fish in bladder cancer was the highest. 4. The sensitivity of AO-F was positively correlated with the clinical stage and pathological grade of the tumor. AO-F parallel FISH is the most valuable method in the diagnosis of bladder cancer. It is suggested that AO-F and FISH can reduce the frequency of cystoscopy.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.14

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