肺癌患者BALF细胞端粒酶活性检测的诊断意义

目的 :对支气管肺癌患者经纤维支气管镜行支气管肺泡灌洗并检测回收液中细胞端粒酶的活性 ,评估端粒酶活性检测对支气管肺癌诊断的临床应用价值。方法 :临床确诊支气管肺癌 15例 ,其它良性非肿瘤性病变 15例 ,除了常规的影像学检查外 ,均行常规电子支气管镜检查并作支气管肺泡灌洗收集回收液 ;采用TRAP -PCR -ELISA测定回收液中端粒酶活性 ;评价端粒酶活性诊断的效能并比较其和临床确诊、支气管镜诊断的两两关系。结果 :15例肺癌患者中端粒酶活性阳性 11例 ,阳性率 73% ,漏诊 4例 ,漏诊率 2 7% ;良性病变中端粒酶活性阳性 3例 ,误诊率 2 0 % ;诊断的敏感性和特异性分别为 73%和 80 % ,阳性预测值和阴性预测值分别为 78%和 75 % ,阳性似然比和阴性似然比分别为 3.6 5和 0 .338,诊断正确率为 77% ,阳性优势比为 3.5 5 ,Youden指数J值为 0 .5 3。端粒酶活性和临床确诊比较 χ2 =0 .14,P >0 .0 1;端粒酶活性和支气管镜诊断比较 χ2 =0 .5 ,P >0 .0 1。结论 :支气管肺泡灌洗液中端粒酶的检测可作为临床诊断支气管肺癌的一项辅助手段

The Diagnostic Significance of Telomerase Activity by BALF Cell from the Patients with Lung Cancer

Objective: To detect telomerase activity of BALF cell from the patients with lung cancer by bronchia endoscope and to evaluate the value of clinical application examining telomerase activity for the diagnosis of bronchogenic carcinoma. Methods: Using electronic bronchoscope and collecting bronchoalveolar lavage fluid (BALF) in 15 cases with bronchogenic carcinoma and 15 cases with benign non-neoplastic disease besides using routine image analysis, the telomerase activity was examined by TRAP-PCR-ELISA from BALF and the efficiency of the telomerase activity for diagnosis was assessed by comparing that with clinical and endoscopic diagnosis. Results: Of 15 lung cancer cases 11 cases were positive telomerase activity and the positive rate was 73%. 4 cases were missed diagnosis and the rate of missed diagnosis was 27%. 3 cases with benign disease were positive telomerase activity and misdiagnosis rate was 20%. The sensitivity and specificity for diagnosis are 73% and 80% respectively. The positive predictive value and the negative predictive value are 78% and 75% respectively. The positive likelihood ratio and the negative likelihood ratio are 3.65 and 0.338 respectively. The accuracy is 77% and the positive odds ratio is 3.55. The Youden index J is 0.53. Comparing the telomerase activity with clinical diagnosis and bronchoscope diagnosis χ 2 are 0.14 and 0.5 respectively, both of P> 0.01. Conclusions: Examining telomerase activity from BALF may be an assisted method for the clinical diagnosis of bronchogenic carcinoma.