目的 探讨MN/CA9和Ep-cam 基因检测对良、恶性胸腔积液鉴别诊断的价值.方法 选择35例恶性胸腔积液(MPE)和30例良性胸腔积液(BPE),采用SYBR Green I FQ RT-PCR检测胸水沉淀细胞中MN/CA9 mRNA、Ep-cam mRNA的表达,胸水找脱落细胞,免疫化学发光法检测胸水CEA水平.结果 MN/CA9和Ep-cam基因在良、恶性胸腔积液中的表达均有明显差异(均P＜0.01).对MPE的诊断,用FQ RT-PCR方法检测MN/CA9 mRNA和Ep-cam mRNA的敏感性(SN)均高于其它两项检查,差异均有统计学意义(均P＜0.05),而特异性(SP)无统计学差异(均P ＞0.05).细胞学阴性的MPE,MN/CA9诊断的SN为55.6%,SP为100%;Ep-cam诊断的SN为61.5%,SP为100%;两者联合检测的细胞学阴性MPE的SN为76.9%,SP为100%.结论 SYBR Green I FQ RT-PCR检测MN/CA9和Ep-cam 基因有助于鉴别良、恶性胸腔积液;联合检测MN/CA9和Ep-cam 基因的表达有助于提高细胞学阴性MPE诊断的敏感性.%Objective To investigate the value of expression of the MN/CA9 and Ep-cam mRNA in distinguishing malignant pleural effusion (MPE) from benign pleural effusion(BPE). Methods The pleural fluid specimens were collected from 35 patients with MPE and 30 patients with BPE. The expression of MN/CA9 mRNA and Ep-cam mRNA were detected by SYBR Green I fluorescence quantitative reverse transcription polymerase chain reaction (FQ-RT PCR) in cell pellets. Exfoliated cell cytology and carcinoembryonic antigen (CEA) assay were performed in effusion specimens. Results There were significant differences in expression of MN/CA9 mRNA and Ep-cam mRNA between MPE and BPE (P<0.01). The diagnostic sensitivity (SN) for MPE by MN/CA9 and Ep-cam mRNA expression were much higher than that of exfoliated cytology and CEA assay (P<0.05), but no difference in specificity(P>0.05). The diagnostic sensitivity of MN/CA9 and Ep-cam mRNA expression in MPE with negative cytology was 55.6% and 61.5%, respectively; both had a specificity of 100.0%. The combination of MPE and MN/CA9 mRNA detection had a sensitivity of 76.9% and specificity of 100.0%. Conclusion The detection of MN/CA9 and Ep-cam mRNA by SYBR Green I FQ RT-PCR is of value in distinguishing MPE from BPE with. In cytologically negative MPE the combined detection of MN/CA9 and Ep-cam mRNA expression may improve the diagnostic sensitivity.
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