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目的:探讨膀胱尿路上皮癌术后检测尿肝细胞生长因子(HGF)和核基质蛋白22(NMP22)表达水平在肿瘤复发监测中的临床价值。方法:2005年1月～2009年6月收治膀胱尿路上皮癌患者92例(接受TURBT或膀胱部分切除术者),术后2周开始规律性膀胱灌注化疗药物吡柔比星(THP)。采用酶联免疫吸附法(ELISA)分别检测灌注前、灌注6周、6个月和12个月时尿中HGF和NMP22的含量;对照组为31例健康人。结果:92例膀胱癌患者术后12个月有11例复发,复发率12%。未复发者尿HGF和NMP22含量随膀胱灌注时间的延长呈下降趋势,肿瘤复发时却明显升高,与对照组比较,差异有统计学意义(P<0.05);尿HGF、NMP22含量和尿脱落细胞学检查(VUC)对膀胱尿路上皮癌术后复发诊断的敏感性分别为91%、73%和45%,特异性分别为58%、48%和98%,阳性预测值分别为100%、80%和71.4%,阴性预测值分别为57%、48%和93%。结论:检测尿HGF和NMP22含量可以作为膀胱尿路上皮癌术后肿瘤复发监测及早期诊断的有效指标,二者结合具有较高的敏感性和预测性。
Objective: To investigate the clinical value of detection of urinary hepatocyte growth factor (HGF) and nuclear matrix protein 22 (NMP22) expression in the monitoring of tumor recurrence after bladder urothelial carcinoma. Methods: From January 2005 to June 2009, 92 patients with bladder urothelial carcinoma (TURBT or partial cystal resection) were treated. Regular intravesical instillation of chemotherapeutic drugs, pirarubicin (THP), started 2 weeks after operation. Enzyme-linked immunosorbent assay (ELISA) was used to detect the contents of HGF and NMP22 in urine before perfusion, 6 weeks, 6 months and 12 months after perfusion. The control group was 31 healthy people. Results: Of 92 patients with bladder cancer, 11 had recurrence 12 months after operation, with a recurrence rate of 12%. The levels of urinary HGF and NMP22 in non-relapsed patients decreased with the prolongation of urinary bladder irrigation time, but increased significantly when the tumors recurred (P <0.05). Urinary levels of HGF, NMP22 and urine shedding Cytological examination (VUC) showed a sensitivity of 91%, 73%, and 45% for the diagnosis of postoperative recurrence of bladder urothelial carcinoma, with a specificity of 58%, 48%, and 98%, respectively, with positive predictive values of 100% , 80% and 71.4% respectively. The negative predictive values were 57%, 48% and 93% respectively. Conclusion: The detection of urinary HGF and NMP22 levels can be used as an effective indicator of tumor recurrence and early diagnosis of bladder urothelial carcinoma after operation. The combination of the two has high sensitivity and predictability.