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目的 通过检测胰液、粪便癌基因K ras和抑癌基因p5 3的突变 ,探索早期诊断胰腺癌的手段。方法 1994年至 2 0 0 0年 5月住院和门诊患者共 2 0 1例 ,正常对照 6 0例 ,通过聚合酶链反应 限制片段长度多态性 (PCR RFLP)方法检测胰液、粪便K ras突变 ,PCR SSCP方法检测p5 3突变。结果 胰腺癌患者胰液K ras突变率为 87.8% (36 / 4 1) ,胰腺良性病变为 2 3.5 % (4/ 17)。粪便K ras扩增成功率为 90 .0 % (2 35 / 2 6 1)。胰腺癌患者粪便K ras突变率为 88.0 % (6 6 / 75 ) ,胰腺良性病变为 5 1.1%(2 4 / 4 7) ,正常人粪便K ras突变率为 19.6 % (9/ 4 6 )。胰腺癌胰液细胞p5 3突变率 4 7.4 % (18/ 38) ,胰腺良性疾病为 12 .5 % (2 / 16 )。胰腺癌粪便p5 3突变率为 37.1% (2 3/ 6 2 ) ,慢性胰腺炎为 19.1% (4/ 2 1)。结论 胰腺癌患者胰液K ras突变的敏感性、特异性高 ,可以作为胰腺癌诊断的辅助手段。粪便K ras结合p5 3检测可以提高敏感性 ,在胰腺癌筛选中有潜在的价值 ,联合血清CA19 9等肿瘤标记物检测有助于提高胰腺癌早期诊断率
Objective To explore the means of early diagnosis of pancreatic cancer by detecting pancreatic fluid, fecal oncogene K ras and tumor suppressor gene p53 mutations. Methods A total of 201 hospitalized and outpatients from May 1994 to May 2000 were enrolled in the study. The normal control group consisted of 60 patients. The polymerase chain reaction-restricted fragment length polymorphism (PCR-RFLP) method was used to detect pancreatic juice and stool K ras mutations. The PCR-SSCP method detects p53 mutations. Results The K ras mutation rate in pancreatic juice was 87.8% (36/41) in patients with pancreatic cancer and 23.5% (4/17) in benign pancreatic lesions. The success rate of fecal Kras amplification was 90.0% (2 35 / 2 61). The K ras mutation rate was 88.0 % (6 6 / 75) in pancreatic cancer patients, 5 1.1% (24/47) in benign pancreatic lesions, and 19.6% (9/46) in normal subjects. The mutation rate of p53 in pancreatic pancreatic cancer cells was 4 7.4 % (18/38), and the benign pancreatic disease was 12.5% (2/16). The p53 mutation rate was 37.1% (23/62) in pancreatic cancer and 19.1% (4/21) in chronic pancreatitis. Conclusion The sensitivity and specificity of K ras mutation in pancreatic juice in patients with pancreatic cancer are high and can be used as an aid in the diagnosis of pancreatic cancer. Detection of fecal K ras combined with p53 can increase sensitivity and have potential value in the screening of pancreatic cancer. Combined detection of tumor markers such as serum CA19 9 can improve the early diagnosis rate of pancreatic cancer.