检测尿survivin蛋白辅助诊断膀胱移行细胞癌的临床分析

目的探讨尿survivin蛋白检测在膀胱移行细胞癌辅助诊断中的意义。方法ELISA法检测149例临床Ⅰ～Ⅱ期初发性膀胱移行细胞癌患者和32例健康对照者的尿survivin蛋白浓度，免疫组化法检测患者癌组织中survivin蛋白免疫标记阳性细胞比率。结果膀胱移行细胞癌患者尿survivin蛋白浓度显著高于健康对照者（t=14．07，P〈0．01）；临床分期、病理分级相同并经尿道膀胱肿瘤切除（TURB）术后2年内膀胱移行细胞癌复发者的TURB术前尿survivin蛋白浓度高于未复发者，但未达到显著水平，而复发者癌组织survivin阳性细胞比率显著高于未复发者（Wileoxon秩和检验，P〈0．05）；复发者在确诊膀胱移行细胞癌复发时尿survivin蛋白浓度显著升高，其他2年内未复发者有12．4％尿survivin蛋白阳性；尿survivin蛋白检测法对Grade1和Grade2膀胱移行细胞癌的敏感度分别为65．0％和81．5％，特异度均为90．6％。结论尿survivin蛋白检测可以作为膀胱移行细胞癌群体筛查和TURB术后多次复查的方法，但该检测不能替代膀胱镜检查诊断初发和复发性膀胱移行细胞癌。ELISA法测得TURB术前尿survivin蛋白浓度不能预测膀胱移行细胞癌复发时间。

Urinary survivin assay provides clues in diagnosis of transitional cell carcinoma of bladder

Objective To investigate the value of urinary survivin protein assay in the auxiliary diagnosis of transitional cell carcinoma of bladder (BTCC). Methods To detect urinary survivin protein concentration (USC) of 149 patients with stage I~II new-onset BTCC and 32 healthy controls by ELISA and the ratio of survivin-staining positive BTCC cells to all BTCC cells in the tissue sections from BTCC specimens (TSR) of these patients by immunostaining assay. Results USC of the BTCC patients was significantly higher than that of healthy controls (t=14.07, P<0.01). The patients with recurrent BTCC within 2 years after receiving transurethral resection of the bladder (TURB) was higher, but not significantly, in the USC detected before receiving TURB (pre-TURB USC) and significantly higher (Wilcoxon rank-sum test, P<0.05) in the TSR than the rest of the BTCC patients. USC of all the recurrent BTCC patients significantly increased when definite evidences of their BTCC recurrence were found, but there were 12.4% of the non-BTCC-recurrent patients with increased USC. The sensitivity of urinary suvivin protein assay in Grade 1 BTCC patients and in Grade 2 BTCC patients was 65.0% and 81.5% respectively, and the specificity was 90.6% for both. Conclusion Urinary survivin assay is probably a noninvasive test with high sensitivity and specificity in favor of new-onset and recurrent BTCC examination. pre-TURB USC detected by urinary survivin protein assay provides no prognostic clues in BTCC diagnosis.