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目的:探讨K－RAS 基因突变检测用于癌性胸腔积液的诊断价值.方法:采用PCR－ SSCP技术对58 例癌性及30 例结核性胸腔积液进行K－RAS 基因突变分析.结果:结核性胸液未发现突变,癌性胸液有17 例突变阳性,突变率29－3 ％ ,其中腺癌所致胸腔积液突变率为34－1％ (14/21),鳞癌16－7 ％(2/12).17 例K－RAS 基因突变阳性的胸液中,14 例为肉眼血性,明显高于非血性胸液组,P＜ 0－05.18 例未找到原发病灶的胸液中44－4％ K－ RAS 基因突变阳性.49 例患者随访10 个月,K－RAS 基因突变阳性者死亡率高达80－0 ％ ,而无K－RAS 基因突变者死亡率明显降低,为26－5 ％ ,P＜ 0－05 .结论:K－RAS 基因突变检测是诊断癌性胸腔积液的又一有效手段,在某些情况下显示出特有的优势,并且对预后的判断有一定价值.“,”To evaluate the diagnostic value of the point mutation of K-ras oncogene in malignant pleural effusion,we detected K-ras codon 12,13 mutations in 58 patients with malignant pleural effusion,30 patients with tuberculous pleurisy by polymerase chain reaciton-single strand comformation polymorphisms(PCR-SSCP).We found that K-ras mutation rates were 29.3%(17/58) in the patients with malignant pleural effusion,none positive case in tuberculous pleurisy.Mutations occured in 14 of 41 cases (34.1%) of adenocarcinoma, 2 of 12 squamous cell carcinoma(16.7%).Among 58 patients with malignant pleural effusion,only 49 patients can be traced during 10 months.The mortality was 80.0%(12/15) in the patients with K-ras mutation, significantly higher than 26.5%(9/34) in the cases with negative K-ras mutation( P <0.05).It suggests that K-ras mutation may be a prognostic mark for the patients with malignant pleural effusion.