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目的 :探讨纤支镜检查标本的 p5 3基因突变检测用于肺癌早期诊断的可行性。 方法 :采用聚合酶链反应 单链构象多态性分析 (PCR SSCP)银染技术 ,对 35例怀疑为肺癌病人的 85份纤支镜检查标本行 p5 3基因 5～ 8号外显子突变检测。结果 :发现 10例病人有 p5 3基因突变 (2 8 6 % ) ,其中以 6号外显子突变率最高 (17 1% )。在 85份标本中 ,纤支镜后痰、灌洗和刷检标本的p5 3突变率明显高于相应标本的细胞学阳性率 (t=2 416 0 ,P <0 0 5 )。其中以痰的 p5 3突变率最高 (2 7 6 % ) (t=2 0 2 0 0 ,P <0 0 5 ) ,但活检组织的 p5 3突变率明显低于病理学阳性结果 (t=2 330 0 ,P <0 0 5 ) ,而综合分析所有痰、灌洗、刷检和活检标本的细胞学和病理学阳性率则与 p5 3突变率之间无明显差异。虽然纤支镜表现为支气管内新生物时所获标本 ,其 p5 3突变率 (45 5 % )高于表现为支气管狭窄和 /或管口间嵴增宽 ,粘膜炎症 (分别均为 2 5 0 % ) ,但统计学上无差异。值得注意的是 ,3例有p5 3突变的病人纤支镜仅表现为粘膜炎症。结论 :纤支镜检查标本的p5 3基因突变检测对肺癌的诊断价值优于相应标本的肿瘤细胞学检查。单独取用痰标本 ,即可较理想地进行 p5 3突变检测 ,可作为肺癌早期诊断有价值的方法之一
Objective: To explore the feasibility of using p53 gene mutation detection in bronchoscopic examination for the early diagnosis of lung cancer. METHODS: Polymerase chain reaction single-stranded conformation polymorphism analysis (PCR-SSCP) silver staining technique was used to detect exon 5 mutations of exon 5 of p53 gene in 85 specimens of bronchoscopy suspected to be lung cancer. RESULTS: The p53 gene mutation was found in 10 patients (28.6%). Among them, the mutation rate of exon 6 was the highest (17.1%). In 85 specimens, the mutation rate of p53 in the posterior fistula, lavage, and brushing specimens of bronchoscopy was significantly higher than that of the corresponding specimens (t=2 416 0, P <0 05). Among them, the p53 mutation rate was highest (27.6%) (t = 2 0 2 0 0, P <0 05), but the p53 mutation rate in biopsies was significantly lower than that in pathology (t = 2). 330 0, P <0 0 5 ), but the comprehensive analysis of all sputum, lavage, brushing and biopsy samples of cytology and pathological positive rate and p53 mutation rate was no significant difference. Although bronchoscopy showed specimens obtained from new organisms in the bronchus, the p53 mutation rate (45.5%) was higher than that of bronchial stenosis and/or widening of the septum, mucosal inflammation (25, respectively). %), but there is no statistical difference. It is worth noting that 3 cases of patients with p53 mutation only showed mucosal inflammation. Conclusion : The detection of p53 gene mutations in bronchoscopic specimens is superior to that of the corresponding specimens in the diagnosis of lung cancer. The use of sputum samples alone can be used to detect p53 mutations, which can be used as one of the valuable methods for the early diagnosis of lung cancer.