流式细胞术用于良恶性胸腔积液鉴别诊断的研究--DNA倍体分析和突变型p53蛋白检测

目的研究流式细胞术DNA倍体和细胞周期分析、突变型p53检测用于良恶性胸腔积液鉴别诊断的临床可行性.方法 24例标本(12例恶性,12例良性)采用流式细胞术细胞内抗原检测的直接免疫荧光标记法检测胸腔积液细胞中表达突变型p53的阳性细胞百分率和p53表达的平均荧光强度,并且通过PI染色分析细胞倍型和周期分布.结果流式细胞术DNA倍体分析用于恶性胸腔积液诊断的敏感性为66.7%,特异性100%.倍体分析和细胞学检查联合应用能将诊断的敏感性提高到100%,特异性仍为100%.良性胸腔积液和恶性胸腔积液p53表达有显著性差异.以p53阳性细胞百分率＞90%为阳性标准,p53用于良恶性胸腔积液鉴别诊断的敏感性和特异性分别为83.3%和91.7%.联合p53阳性细胞百分率和DNA倍体分析对恶性胸腔积液诊断的敏感性能提高到91.7%,特异性91.7%.细胞周期SPF(S期时相百分比)在良恶性胸腔积液之间没有显著差异.结论流式细胞术DNA倍体分析和突变型p53检测可以作为临床良恶性胸腔积液鉴别诊断的辅助手段,结合细胞学检查更有意义.

Application of flow cytometry in the diagnosis of malignant pleural effusions

Objective To assess the value of flow cytometric DNA analysis and p53 expression as an adjunct to routine cytology in the diagnosis of malignant pleural effusions(PE).Methods PEs from 24 patients(12 malignant PEs,12 with benign diseases)were studied by conventional cytology,flow cytometric DNA analysis and cytometric detection of p53 expression.In attempt to decide the cell proliferative state,flow cytometric S phase fraction(SPF)were used.Results Cytometric DNA analysis had a sensitivity of 66.7% and a specificity of 100%.If DNA analysis and cytology are combined,sensitivity may reach 100% with the same specificity.The expression of p53 in malignant PEs is significantly higher than that in benign ones.If the percentage of p53-expressing cells higher than 90% is considered as a marker of malignant PE,cytometric p53 expression demonstrated a sensitivity of 83.3% and a specificity of 91.7%.Combined together,cytometric DNA analysis and p53 expression had a sensitivity of 91.7% and a specificity of 91.7%.SPF(S Phase Fraction)is statistically the same between malignant and benign PEs.Conclusions Both flow cytometric DNA analysis and p53 expression provide comparable measurements in the diagnosis of pleural effusions and can be applied as a useful adjunct to conventional cytology,especially when they are combined.