胆汁脱落细胞端粒酶活性检测在胆道恶性肿瘤诊断中的价值

背景与目的：已有学者对尿液,胰液,肠腔冲洗液,胸水等脱落细胞端粒酶活性进行了检测,探索其对恶性肿瘤的诊断价值。而胆汁脱落细胞端粒酶活性的检测尚少见报道。本文的目的是探讨胆汁脱落细胞端粒酶活性检测及其对胆道恶性梗阻的诊断价值。方法：应用TRAP银染法检测胆汁脱落细胞的端粒酶活性。结果：44例恶性肿瘤胆道梗阻病人获得的胆汁中有33例检测到端粒酶活性阳性,阳性率75．0％,而良性梗阻组19例中只有1例检测到端粒酶弱阳性,阳性率5．3％。胆汁脱落细胞端粒酶活性阳性率与淋巴结转移,远处转移以及分化程度等肿瘤临床病理学特征无关,但胰腺癌和胆管癌病人胆汁中端粒酶活性检测阳性率高。端粒酶活性检测与脱落细胞学检查对比结果显示：44例胆道恶性梗阻的病人中31例进行了胆汁脱落细胞学检查,结果只有3例癌细胞阳性,阳性率9．7％,这3例脱落细胞学检查阳性的胆汁脱落细胞端粒酶活性检测均为阳性。结论：TRAP银染法可有效检测到胆汁脱落癌细胞的端粒酶活性。端粒酶可以作为诊断恶性胆道疾病的分子标志物。胆汁中脱落细胞端粒酶活性检测可作为细胞学检查的补充诊断手段。

Detection of telomerase activity of exfoliated cells in bile and its clinical impact

Background &Objective:Some studies revealed that telomera se activity could be detected in exfo liated cancer cells in body fluid such as urine,pancreatic juice,pleural effusion that is a good diagnostic marker f or malignancies.However,few reports about telomera se in exfoliated cancer cells in bile are available.The current study was designed to determine the telomerase activity o f exfoliated cells in bile and its clinical impact in the patients with malignant obstructive jaundice.Methods:Telomerase activity was determined by using a modified PCR-based telome ric repeat amplification protocol(TRAP)-sliver stain assay.Result:Telomerase activity was detected in33of 44(75%)bile specimens from patients with malignant tumor.In contrast,only 1of 19(5.3%)bile samples from cholelithiasis wa s telomerase positive.There was no relation ship between the positiv e rate of telomerase activity and the clinicopathological finds includi ng metastatic status and differentiation,but telomerase positive rate was higher in bile fro m patients with pancreatic carcionm a and cholangiocarcinoma.Comparison of telomerase assay with cytologic examination showed that,among the 44patients with malignant obstructive jaundice,31cases underwent cytological examin ation,cancer cells were found only i n 3(9.7%)bile specimens,and all cytological exam ination positive specimens were telomerase positive.Conclusion:The TRAP assay can effectively detect telomerase activity of the exfoliated cancer cells in bile.Telomerase could be a molecu lar marker for diagnosis of malignan t bile duct disease.The detection of telomerase activity in bile could become a usefu l adjunct in the cytologic examinati on.