应用定量PCR方法动态检测膀胱癌患者尿脱落细胞中survivin mRNA的表达及其临床意义

背景与目的：膀胱癌是泌尿系统最常见的恶性肿瘤，目前临床上缺乏理想的早期诊断方法。本研究通过检测膀胱移行细胞癌（bladder transitional cell carcinoma，BTCC）患者手术前后尿脱落细胞中survivinm RNA的表达，探讨其在BTCC患者早期诊断和术后监测肿瘤复发中的意义。方法：采用实时荧光定量PCR（real-time PCR）法检测10例健康志愿者、15例膀胱炎患者和30例初发BTCC患者术前及术后1周、1个月、6个月定期随访至15个月尿脱落细胞中survivin mRNA的表达情况。结果：30例BTCC患者术前尿脱落细胞中survivin mRNA的相对拷贝数为96．01±42．33。明显高于正常对照组及膀胱炎组（P〈0．05）。术后1周（25．30±1．51）较术前显著下降（P〈0．05）；术后1个月（13．20±1．49）、术后6个月（13．90±1．36）与正常对照组比较差异均无统计学意义（P〉0．05）；随访至15个月，3例复发患者复发时的相对拷贝数为97．83±27．47，与术后6个月相比差异有统计学意义（P〈0．05）。结论：尿脱落细胞中survivin mRNA的表达作为诊断膀胱移行细胞癌的指标敏感性高，术后动态随访survivin mRNA表达变化可监测复发。

Expression of survivin mRNA in urine exfoliated cells of patients with bladder transitional cell carcinoma detected by real-time PCR

Background and Objective： Bladder cancer is the most malignant cancer of the urinary system. However a noninvasive and sensitive method of the early diagnosis for bladder cancer has not been developed. This study was to explore the expression of survivin mRNA in urine exfoliated cells of preoperative and postoperative patients with bladder transitional cell carcinoma （BTCC）, and to analyze its value in early diagnosis and postoperative monitoring. Methods： Urine of 30 patients with initially diagnosed BTCC was collected before operation and one week, one month, six months and 15 months after operation. Urine of 10 healthy volunteers and 15 patients with cystitis was used as control. Expression of survivin mRNA in urine exfoliated cells was detected by real-time fluorescent quantitative polymerase chain reaction （real-time PCR）. Results： The relative copy number of survivin mRNA in the patients was 96.01 ±42.33 before operation, which was significantly higher than that of healthy volunteers and cystitis patients （P 〈 0.05）. The level of survivin mRNA was apparently declined one week after operation （25.30±1.51） compared with its preoperative level （P 〈0.05）; and the level became as low as the control group after one month （13.20±1.49） and six months （13.90±1.36） （P〉0.05）. Patients were followed up for 15 months, and three patients recurred, whose survivin mRNA level （97.83± 27.47） was significantly higher than that at six months after operation （P 〈 0.05）. Conclusion： Detecting survivin mRNA in urine exfoliated cells is sensitive for the diagnosis of BTCC. Detecting survivin mRNA after operation can monitor recurrence.