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1、1CEAmRNA【关键词】 癌胚抗原Different expression and clinical application of CEAmRNACEAp system in benign and malignant ascites【Abstract】 AIM: To understand the different expression of carcinoembryonic antigen mRNA (CEAmRNA)carcinoembryonic antigen protein (CEAp) system in benign and malignant ascites and to
2、assess the value of CEAmRNACEAp for the diagnosis and differential diagnosis of benign and malignant ascites. METHODS: Ninetythree patients were examined, among whom 60 cases were with malignant ascites and 33 cases with benign ascites. The ascites were collected and used for CEAmRNA and CEAp detect
3、ion. CEAmRNA was detected by reverse transcriptasenested primerspolymerase chain reaction (RTNPPCR) and CEAp was detected by magnetic antibody immunoenzymometric assay (MAIA). RESULTS: The positive rates of CEAmRNA and CEAp were 49 (81.7%) and 34 (56.7%) in the malignant ascites group and 1 (3.0%) a
4、nd 3 (9.1%) in 2the benign ascites group.The positive rates of both CEAmRNA and CEAp in the ascites of patients with malignant ascites were significantly higher than those of benign patients (P0.01). In the diagnosis and differential diagnosis of malignant ascites, the specificity, sensitivity, the
5、positive likelihood ratio, the negative likelihood ratio, the positive predictive value, the negative predictive value and the accuracy of CEAmRNA and of CEAp were respectively 0.970 and 0.909, 0.817 and 0.567, 27.233 and 6.231, 0.189 and 0.476, 0.980 and 0.919, 0.744 and 0.544, 0.871 and 0.699. CON
6、CLUSION: Both CEAmRNA and CEAp are useful indexes for the diagnosis and differential diagnosis of malignant ascites. The diagnostic efficiency of CEAmRNA is higher than that of CEAp.【Keywords】 carcinoembryonic antigen; RNA, messenger; carcinoembryonic antigen protein; diagnosis, differential; ascite
7、s, malignant【摘要】 目的： 了解癌胚抗原信使核糖核酸 (CEAmRNA)癌胚抗原蛋白(CEAp)系统在良、恶性腹水中表达的差别，评估检测CEAmRNACEAp 系统指标诊断与鉴别诊断良、恶性腹水的应用价3值. 方法： 恶性腹水组 60 例，良性腹水组 33 例. 采集腹水为检测标本，应用反转录套式聚合酶链反应(RTNPPCR)技术检测CEAmRNA，磁性抗体分离酶免疫测定(MAIA)技术检测 CEAp. 结果： 良、恶性组腹水中 CEAmRNA 和 CEAp 的阳性率分别为3.0%(1/33)和 9.1%(3/33)，81.7%(49/60)和 56.7%(34/60)，良、恶性
8、腹水间均具有显著的统计学差异(P16 g/L为阳性. 检测操作详按试剂盒操作说明书进行. 三波长磁分离酶免疫测定系统为美国 Biozyme1 仪器.统计学方法： 应用卡方检验对检测结果进行统计学分析，以P16 g/L为阳性结果) 处理.2 结果在恶性腹水组内 PCR 检测 CEAmRNA 的阳性率为81.7%，MAIA 检测 CEAp 的阳性率为 56.7%, CEAmRNA 与 CEAp同时阳性结果的有 33 例，CEAmRNA 阳性而 CEAp 阴性的有 16例，CEAp 阳性而 CEAmRNA 阴性的有 1 例，CEAmRNA 的阳性率高于 CEAp 的阳性率(配对校正卡方检验，2=11
9、.529, P0.01).在良性组内 CEAp 的阳性结果(3/33)略高于 CEAmRNA(1/33). CEAmRNA 和 CEAp 指标诊断与鉴别诊断恶性腹水的特异度(specificity)、敏感度(sensitivity)、阳性似然比(PLR)、阴性似然比(NPR)、阳性预测值(PPV)、阴性预测值(NPV)、准确度(accuracy)分别为 0.970 和 0.909, 0.817 和 0.567, 27.233 和 6.231, 0.189 和0.476, 0.980 和 0.919, 0.744 和 0.544, 0.871 和 0.699.表 1 各组腹水标本检测 CEAmR
10、NA 和 CEAp 的阳性结果（略）3 讨论CEAp 是肿瘤及某些幼稚细胞合成的蛋白质，是常用的肿瘤标志物，但敏感性较低2,3 . CEAmRNA 是指导合成 CEAp 的模板，它不能在细胞外存在，与肿瘤关系密切，是新近热点研究的肿7瘤标志物1,4-7. 如在浆膜腔内发现 CEAmRNA 表达，多提示其中有肿瘤生长或发生肿瘤的转移4. 我们实验显示，恶性腹水CEAmRNA 和 CEAp 的阳性结果显著高于良性腹水，且 CEAmRNA的敏感性显著高于 CEAp；同时还发现，CEAmRNA 可早于其它指标被阳性发现而提供肿瘤信息. 我们研究表明，CEAmRNACEAp 系统在恶性腹水时被高度活跃表达，其中 CEAmRNA 指标优于CEAp，具有更高的应用价值.【参考文献】1 Gerhard M, Juhl H, Kalthoff H, et al. Specific detection of carcinoembryonic antigenexpressing tumor cells in bone marrow aspirates by polymerase chain reaction J. J Clin Oncol, 1994; 12(4): 725-72
