【摘要 】 目的 从分子生物学检测角度来寻求敏感的肺癌诊断新方法。方法 应用多聚合酶链反应(PCR)结合限制性长度片段多态性分析法(RFLP)及免疫组化技术(IHC)，检测62例肺癌和34例肺部良性疾病患者痰标本中k-ras、p53基因的突变状况，检测结果与组织学、脱落细胞学诊断进行对比分析。结果 肺癌痰标本的脱落细胞学敏感性为61%、阴性预计值(NPV)为59%；p53阳性表达的敏感性为77%、NPV为66%；k-ras变异阳性的敏感性为34%、NPV为42%；p53、k-ras和痰脱落细胞学联合检测：敏感性提高至92%(P<0.05)、NPV为84%(P<0.05)。24例痰细胞学假阴性痰标本中p53或k-ras变异阳性17例(71%)。结论 痰标本p53、k-ras的联合检测可增加痰检的敏感性，补充和提高脱落细胞学的诊断价值。

Wang Ling,Wang Guangjie,Xia Xueming, et al. The First Affiliated Hospital Suzhou Medical College, Suzhou 215006

【Abstract 】 Objective To find a new method to molecular biological detection of lungcancer. Method The sputum specimens from 96cases of lung cancer and other lung patients were detected for K-ras and p53 mutations byusing polymerase chain reaction(PCR) and restriction fragment length polymorphism and andimmunohistoche mistry (IHC) tecniques. Result 38 out of 62 sputum specimens of lung cancer patients were positivefor cytology: Sensitivity was 61%. NPV (negative predictive value) was 59%;p53 wasoverexpressed in 48 cases:Sensitivity was 77%.NPV was 66%;k-ras was positive in 21cases:Sensitivity was 34%, NPV 42%;The combination of conventional cytology and molecularscreening(k-ras+p53) produced a sensitivity value of 92%(P<0.05) with an NPV of84%(P<0.05);In 24 cases of patients whose cytology of sputum was false negtive, 17 werefound either p53 or k-ras positive of which 7 patients were identified to be lung cancerin the follow-up study. Conclusion These results suggest that detection of oncogene mutation in sputumenhanced and added to the diagnostic value of conventional cytology. It is a promisingapproach to early lung cancer detection and massive screeing in terms of itsrapidity,economy and simplicity.

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