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目的探讨DNA异倍体检测在肺癌筛查和早期诊断中的应用价值。方法对679例肺部疾病患者的支气管镜刷检、活检组织(支气管镜活检、手术切除)标本(280例)及胸腔积液脱落细胞399例经常规处理、HE染色,进行病理学检查,采用Motic全自动细胞DNA定量分析系统检测标本中的DNA异倍体,同时分别测定血清、胸腔积液中肿瘤标志物CEA含量。结果全自动细胞DNA定量分析与组织学检测、细胞学检测及血清癌胚抗原(CEA)检测结果之间比较无统计学差异(P>0.05);DNA异倍体的检测结果与胸腔积液的病理学检测、脱落细胞学检测及血清/胸水CEA等检测结果之间亦无统计学差异(P>0.05)。其中,DNA异倍体检测灵敏度及特异度均略低于常规支气管刷片,而与血清CEA检测结果无差异;胸水中DNA异倍体检测的灵敏度与特异度亦均低于胸水脱落细胞学及胸水CEA检测,但与血清CEA检测结果无差异。同时,DNA异倍体在早期及晚期肺癌的检出结果中未见明显统计学差异(P>0.1)。结论全自动DNA定量分析技术是一种敏感而特异的肺癌的筛查技术;DNA异倍体可能属于肺癌发生的早期事件,检测DNA异倍体有望作为肺癌早期诊断与筛查的有价值的标志物;DNA异倍体与支气管镜刷检或与CEA联合检测可提高肺癌诊断的阳性率。
Objective To investigate the value of DNA aneuploidy in the screening and early diagnosis of lung cancer. Methods Bronchoscopy, biopsy (bronchoscopic biopsy, surgical resection) specimens from 679 patients with pulmonary diseases (39 cases) and routine biopsy specimens from 397 patients with pleural effusion cells were routinely stained with HE for pathological examination. Motic automatic cell DNA quantitative analysis system for detection of DNA aneuploidy, at the same time were measured serum, pleural effusion tumor marker CEA content. Results There was no significant difference between quantitative analysis of DNA and histological examination, cytological examination and CEA test (P> 0.05). The results of DNA aneuploidy and pleural effusion There was no significant difference between pathology, exfoliative cytology and serum / pleural effusion CEA (P> 0.05). Among them, the detection sensitivity and specificity of DNA aneuploidy were slightly lower than those of conventional bronchial brush, but no difference with serum CEA test. The sensitivity and specificity of DNA aneuploidy in pleural effusion were also lower than that of pleural effusion cytology and Pleural effusion CEA test, but no difference with the serum CEA test results. At the same time, DNA aneuploidy showed no significant difference in the detection of early and advanced lung cancer (P> 0.1). Conclusion Automated DNA quantification is a sensitive and specific screening technique for lung cancer. DNA aneuploidy may be an early event in lung cancer detection. Detecting DNA aneuploidy is expected to be a valuable marker for early diagnosis and screening of lung cancer DNA aneuploidy and bronchoscopy brush or CEA combined detection can increase the positive rate of lung cancer diagnosis.