尿液检查在膀胱癌诊断和术后复发监测中的现状及进展

膀胱癌是我国男性泌尿生殖系统肿瘤中的最常见肿瘤.膀胱镜检查是诊断和治疗后随访的最主要手段,但其往往会带给患者痛苦和恐惧.无创性的尿液检查替代膀胱镜诊断膀胱癌、监测复发及判断预后,一直是研究的热点.除尿细胞学外,目前通过尿液检查诊断和监测膀胱癌复发主要有尿核基质蛋白22、膀胱肿瘤抗原、免疫-细胞检查法、纤维素和纤维蛋白降解产物及荧光原位杂交技术等方法,但敏感性和特异性均不十分理想.检测尿液的端粒酶、透明质酸和透明质酸酶的方法其敏感性和特异性较好,但尚未经多中心的研究证实.对膀胱癌尿液中新的肿瘤标志物的初步研究结果表明,微卫星体异常、一些基因启动子的异常甲基化、细胞角蛋白、survivin等在膀胱癌的诊断中有较大的应用价值,但目前这些方法均有其局限性.合理地联合应用上述无创性尿液分析手段,可望推迟或减少膀胱镜检查,但尚难以取代膀胱镜.

Current status and advances on detection of the urine for diagnosis and follow-up of bladder cancer

Bladder cancer is the most common malignancy of genitourinary system in China.Cystoscopy is the gold standard for diagnosis and follow-up of bladder cancer,but it often brings patient pain and fear.Most investigations are now focusing on developing new non-invasive methods for detection of the urine for diagnosis and monitoring recurrence of bladder cancer.Besides the urine cytology,the non-invasive methods approved by FDA include NMP22,BTA,Immunocyt,FB/FDP and UroVysion examinations now,however,all of which are not highly sensitive and specific.Though detection of telomerase,hyaluronic acid/hyaluronidase of the urine have better sensitivity and specificity,their role for diagnosis and follow-up of bladder cancer still need to be validated by multicenter clinical study.Novel tumor markers,such as microsatellite instability,hypermethylation of the promoter of certain genes,cytokeratins and survivin are potentially useful,but they all have limitations when clinically used.When combinednon-invasive detections of the urine were reasonably applied,patients with bladder cancer would be expected to receive less or prolonged examinations of cystoscopy.