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目的 探讨检测肺癌患者区域淋巴结、外周血和骨髓中微转移在肺癌外科治疗中的临床意义 ,以及区域淋巴结、外周血和骨髓肺癌微转移三者之间的相关性。方法 应用巢式RT PCR技术 ,对 2 9例肺癌患者和 1 1例肺良性病变患者的淋巴结、外周血和骨髓中CK1 9基因mRNA表达进行联合检测。结果 本实验建立的巢式RT PCR技术的敏感性可达到 1 0 - 6。术前 1 0例患者检测到外周血微转移 ,6例患者检测到骨髓肺癌微转移 ,1 0 1枚纵隔淋巴结中 5 5枚检测到肺癌微转移。肺癌患者淋巴结、外周血和骨髓中微转移阳性检出率分别为 5 4 .5 %、3 4 .5 %和 2 0 .7% ,三者之间存在显著正相关 (P <0 .0 5 ) ,外周血和骨髓微转移与肺癌组织学类型、细胞分化程度及P TNM分期均存在密切关系 (P <0 .0 5或P <0 .0 1 )。结论 RT PCR法是一种特异性 ,敏感性均较高的肿瘤微转移检测方法 ;检测CK1 9mRNA表达应用于肺癌微转移的分子诊断有助于选择外科手术适应证 ,并具有广阔的临床应用前景
Objective To explore the clinical significance of detecting micrometastases in regional lymph nodes, peripheral blood, and bone marrow in surgical treatment of lung cancer in patients with lung cancer, as well as the correlation among regional lymph nodes, peripheral blood, and bone marrow micrometastasis. Methods Nested RT PCR was used to detect the expression of CK1 9 mRNA in lymph node, peripheral blood and bone marrow of 29 lung cancer patients and 11 benign pulmonary lesions. Results The sensitivity of nested RT PCR technology established in this experiment can reach 10-6. Peripheral blood micrometastasis was detected in 10 patients before operation, micrometastasis in bone marrow and lung cancer was detected in 6 patients, and micrometastasis was detected in 55 of 101 mediastinal lymph nodes. The positive rate of micrometastases in lymph node, peripheral blood and bone marrow of lung cancer patients was 54.5%, 34.5%, and 20.7%, respectively. There was a significant positive correlation between the three (P < .05). There was a close relationship between micrometastasis in peripheral blood and bone marrow and histological type, cell differentiation and P TNM stage (P <0.05 or P <0.01). Conclusion The RT PCR method is a specific and sensitive method for detection of tumor micrometastases. Detection of CK1 9 mRNA expression for molecular diagnosis of lung cancer micrometastases is helpful for the selection of surgical indications and has broad clinical application prospects.