CAJ | 학술논문

目的探讨流式细胞术检测非小细胞肺癌(NSCLC)特异性循环肺癌细胞(SCLCC)的临床应用价值.方法采用特异性识别SPC-A1的单克隆抗体NJ001进行荧光标记,建立流式细胞术检测SCLCC的方法.采用病例对照研究方法,对收集到的2013年3至7月南京医科大学第一附属医院43例NSCLC患者、15例肺部良性疾病患者和35名健康对照者外周血进行SCLCC水平检测,用秩和检验分析各组之间的差异,并绘制ROC曲线分析.同时将43例NSCLC患者的SCLCC水平与电化学发光法检测癌胚抗原(CEA)、角质蛋白19片段(CYFRA21-1)和神经元特异性烯醇化酶(NSE)水平采用x2检验进行比较.结果 NSCLC患者的SCLCC水平为75(16～128)/20万个PBMC,高于肺部良性疾病患者的5(0 ～30)/20万个PBMC和健康对照者的0(0 ～15)/20万个PBMC,差异有统计学意义(Z=-3.373、-5.240,P＜0.05);NSCLC患者SCLCC的ROC曲线下面积为0.831,最佳诊断临界值为30/20万个PBMC,对应的敏感度为65％,特异度为92％;其中25例NSCLC患者手术之前的SCLCC为78(12～120)/20万个PBMC,显著高于手术之后的17(0～104)/20万个PBMC,差异有统计学意义(Z=-2.005,P＜0.05);另外43例NSCLC患者的SCLCC阳性率为65％,显著高于电化学发光法的CEA、CYFRA21-1和NSE(35％、14％和23％),差异有统计学意义(x2=5.76、16.96、13.14,P＜0.05).结论应用流式细胞术检测SCLCC具有较高敏感度、特异度和准确性,具有重要的临床价值.
목적 탐토류식세포술검측비소세포폐암(NSCLC)특이성순배폐암세포(SCLCC)적림상응용개치.방법 채용특이성식별SPC-A1적단극륭항체NJ001진행형광표기,건립류식세포술검측SCLCC적방법.채용병례대조연구방법,대수집도적2013년3지7월남경의과대학제일부속의원43례NSCLC환자、15례폐부량성질병환자화35명건강대조자외주혈진행SCLCC수평검측,용질화검험분석각조지간적차이,병회제ROC곡선분석.동시장43례NSCLC환자적SCLCC수평여전화학발광법검측암배항원(CEA)、각질단백19편단(CYFRA21-1)화신경원특이성희순화매(NSE)수평채용x2검험진행비교.결과 NSCLC환자적SCLCC수평위75(16～128)/20만개PBMC,고우폐부량성질병환자적5(0 ～30)/20만개PBMC화건강대조자적0(0 ～15)/20만개PBMC,차이유통계학의의(Z=-3.373、-5.240,P＜0.05);NSCLC환자SCLCC적ROC곡선하면적위0.831,최가진단림계치위30/20만개PBMC,대응적민감도위65％,특이도위92％;기중25례NSCLC환자수술지전적SCLCC위78(12～120)/20만개PBMC,현저고우수술지후적17(0～104)/20만개PBMC,차이유통계학의의(Z=-2.005,P＜0.05);령외43례NSCLC환자적SCLCC양성솔위65％,현저고우전화학발광법적CEA、CYFRA21-1화NSE(35％、14％화23％),차이유통계학의의(x2=5.76、16.96、13.14,P＜0.05).결론 응용류식세포술검측SCLCC구유교고민감도、특이도화준학성,구유중요적림상개치.
Objective To explore the clinical application value of flow cytometry in detecting specific circulating lung cancer cell (SCLCC) for non-small cell lung cancer (NSCLC).Methods The flow cytometry was established by fluorescent monoclonal antibody NJ001 which can specific recognize the SPC-A1.On basis of detecting the SCLCC,a case-control study was conducted.43 NSCLC patients were compared with 15 benign lung disease patients and 35 healthy controls from the First Affiliated Hospital of Nanjing Medical University by rank-sum test.The difference was also evaluated between before and after surgery for 25 NSCLC patients.The data were analyzed by ROC curve to assess the diagnostic value.Meanwhile,CEA,CYFRA21-1 and NSE were measured by ECLIA for comparison with SCLCC in 43 NSCLC patients by chisquare test.Results The levels of SCLCC in patients of NSCLC,benign lung disease and healthy controls were 75 (16-128)/200000 PBMC,5 (0-30)/200 000 PBMC,0 (0-15)/200 000 PBMC.The SCLCC of NSCLC patients were obviously higher than that of benign lung disease patients and healthy controls (Z =-3.373,-5.240,P ＜ 0.05).According to ROC curve,the area under the curve was 0.831 and the optimal diagnostic critical value was 30/200 000 PBMC,with higher sensitivity (65％) and specificity (92％).The levels of SCLCC before and after surgery in 25 NSCLC patients were 78 (12-120)/200000PBMC and 17(0-104)/200000 PBMC.There were significant differences between them(Z =-2.005,P＜0.05).Meanwhile,the positive rate of SCLCC in NSCLC was 65％,and obviously higher than the positive rate of CEA (35％,x2 =5.76,P ＜ 0.05),CYFRA21-1 (14％,x2 =16.96,P ＜ 0.05) and NSE(23％,x2 =13.14,P ＜ 0.05).Conclusion Determination of SCLCC by flow cytometry for NSCLC had higher sensitivity,specificity and clinical value,which suggested that it is a valuable detection technology for NSCLC.