恶性浆膜腔积液脱落细胞中P21 ras蛋白表达状况及其意义

目的:检测浆膜腔积液脱落细胞P21 ras蛋白表达状况,探讨其对恶性浆膜腔积液的诊断价值.方法:将新鲜浆膜腔积液离心后收集脱落细胞,取部分细胞涂片进行常规细胞学诊断,据此将积液分为良性与恶性两组.对余下脱落细胞作"标准化"处理,包括去除红细胞、多聚甲醛固定、调整细胞浓度、制备细胞涂片,然后进行P21 ras蛋白免疫化学染色(SP法).结果:共108例浆膜腔积液,恶性53例,良性55例.39例恶性积液P21 fas蛋白免疫化学染色阳性(73.6%),且多为强阳性或阳性;12例良性积液P21 ras蛋白染色阳性(21.8%),且多为弱阳性或阳性,两组间阳性率(χ2=29.02,P＜0.001)及阳性强度(Uc=6.786,P＜0.001)的差异均有显著性统计学意义.P21 ras蛋白免疫化学染色诊断恶性积液的敏感度为73.6%,特异度为78.2%,诊断符合率达75.9%.结论:浆膜腔积液中脱落细胞P21 ras蛋白免疫化学染色在肿瘤细胞多为阳性,良性细胞多为阴性,对恶性体腔积液的诊断有较大的价值.

Expression of P21 ras protein in malignant serous cavity effusions and its significance

AIM: To investigate the expression of P21 ras protein in the exfoliative cells from malignant serous cavity effusions and its diagnostic value. METHODS: Exfoliative cells in fresh specimens of serous cavity effusions were collected after centrifugation, and cell smears were prepared for cytological diagnosis, by which the specimens were divided into benign or malignant groups. The remained exfoliative cells were processed with a "standardized" procedure: removing red cells, fixing in paraformaldehyde, adjusting the cell concentration, and finally, cell smears were prepared and P21 ras immunocyto-chemistry were performed (SP method). RESULTS: A total of 108 effusion specimens were collected, including 53 malignant and 55 benign one. In the immunocytochemical staining of P21 ras, 39 of 53 malignant effusions were positive (73.6%), and most of them were strongly positive. The positive results were observed in 12 of 55 (21.8%) benign effusions, most of which were weakly positive. The positive rates (X2 = 29.02, P < 0.001) and expression intensity (Uc = 6.786, P < 0.001) of P21 ras were significantly different between malignant and benign effusions. The sensitivity, specificity and diagnostic accordance rate of P21 ras immunocytochemistry in the diagnosis of malignant effusions were 73.6%, 78.2% and 75.9%, respectively. CONCLUSION: P21 ras immunocytochemical staining of exfoliative cells is positive in most malignant effusions, but negative in most benign ones, implicating that it is valuable for the diagnosis of malignant effusions.