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目的 通过检测胰液、粪便癌基因K ras和抑癌基因p5 3的突变 ,探索早期诊断胰腺癌的手段。方法 1994年至 2 0 0 0年 5月住院和门诊患者共 2 0 1例 ,正常对照 6 0例 ,通过聚合酶链反应 限制片段长度多态性(PCR RFLP)方法检测胰液、粪便K ras突变 ,PCR SSCP方法检测p5 3突变。结果 胰腺癌患者胰液K ras突变率为 87 8% (36 / 41) ,胰腺良性病变为 2 3 5 % (4/ 17)。粪便K ras扩增成功率为90 0 % (2 35 / 2 6 1)。胰腺癌患者粪便K ras突变率为 88 0 % (6 6 / 75 ) ,胰腺良性病变为 5 1 1% (2 4 / 47) ,正常人粪便K ras突变率为 19 6 % (9/ 46 )。胰腺癌胰液细胞p5 3突变率 4 7 4 % (18/ 38) ,胰腺良性疾病为 12 5 % (2 / 16 )。胰腺癌粪便p5 3突变率为 37 1% (2 3/ 6 2 ) ,慢性胰腺炎为 19 1% (4/ 2 1)。结论 胰腺癌患者胰液K ras突变的敏感性、特异性高 ,可以作为胰腺癌诊断的辅助手段。粪便K ras结合p5 3检测可以提高敏感性 ,在胰腺癌筛选中有潜在的价值 ,联合血清CA19 9等肿瘤标记物检测有助于提高胰腺癌早期诊断率。
Objective To explore the early diagnosis of pancreatic cancer by detecting the mutations of pancreatic juice, stool cancer gene K ras and tumor suppressor gene p5 3. Methods Totally 201 inpatients and outpatients from 1994 to 2000 were selected, and 60 controls were used as normal controls. PCR-RFLP was used to detect pancreatic juice and faecal K ras mutation by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) , PCR SSCP method to detect p5 3 mutation. Results The pancreatic K ras mutation rate was 87.8% (36/41) in pancreatic cancer patients and 235% (4/17) in benign pancreatic diseases. The success rate of faecal K ras amplification was 90 0% (2 35/2 6 1). The rate of K ras mutation was 88% (6/75) in pancreatic cancer patients, 51.1% (24/47) in benign pancreatic diseases, and 19 6% (9/46) in normal human. . Pancreatic cancer pancreatic juice p5 3 mutation rate of 474% (18/38), pancreatic benign disease was 125% (2/16). Pancreatic cancer stool p5 3 mutation rate was 37.1% (2/6 2), chronic pancreatitis was 19 1% (4/2 1). Conclusion The sensitivity and specificity of K ras mutation of pancreatic juice in patients with pancreatic cancer are high and can be used as an adjunct to the diagnosis of pancreatic cancer. Stool K ras combined with p5 3 detection can improve the sensitivity of pancreatic cancer screening has potential value, combined with serum CA19 9 and other tumor markers detection can help improve the early diagnosis of pancreatic cancer.