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目的评价联合运用尿膀胱癌抗原(UBC)、透明质酸(HA)和存活素诊断膀胱癌的临床应用价值。方法64例膀胱癌患者、20例泌尿系良性疾病患者在膀胱镜检查前留尿,分别进行UBC、HA、存活素和脱落细胞学检测,比较4种方法诊断膀胱癌的价值。膀胱癌患者肿瘤分级G_1 11例,G_2 38例,G_3 15例；病理分期pT_(is) 2例,pT_1 36例,pT_1 16例,≥pT_2 10例。结果UBC、HA和存活素诊断膀胱癌的敏感性分别为85.9%(55/64)、89.1%(57/64)、93.8%(60/64),与脱落细胞学(40.6%)比较,差异有统计学意义(P＜0.01),4种方法诊断膀胱癌的特异性分别为85.0%(17/20)、80.0%(16/20)、95.0%(19/20)和95.0%(19/20)。各分级和分期UBC、HA和存活素诊断膀胱癌的敏感性均高于尿脱落细胞学检查；UBC值各分级和分期比较差异无统计学意义(P＞0.05)。HA检测值G_2、G_3组均明显高于G_1组(P＜0.01),但G_2、G_3组间比较差异无统计学意义(P＞0.05)；各分期之间比较差异无统计学意义(P＞0.05)。存活素检测各分级和分期之间比较差异无统计学意义(P＞0.05)。而对尿细胞学来说,肿瘤分级越高,敏感性越高(P＜0.01),各分期之间比较差异无统计学意义(P＞0.05)。联合应用UBC、HA和存活素诊断膀胱癌的敏感性和特异性均达到100%。结论尿中UBC、HA和存活素是早期诊断膀胱癌的较好肿瘤标记物,3项检测联合能提高诊断的敏感性和特异性。
Objective To evaluate the clinical value of combined application of urinary bladder cancer antigen (UBC), hyaluronic acid (HA) and survivin in the diagnosis of bladder cancer. Methods Sixty-four patients with bladder cancer and 20 patients with urinary tract benign disease were enrolled before the cystoscopy. UBC, HA, survivin and exfoliated cytology were detected respectively. The diagnostic value of four methods for bladder cancer was compared. There were 11 cases of G 1, 38 cases of G 2 and 15 cases of G 3 in bladder cancer. There were 2 cases of pT_ (is) in pathological stage, 36 cases of pT_1, 16 cases of pT_1, and 10 cases of ≥pT_2. Results The sensitivity of UBC, HA and survivin in the diagnosis of bladder cancer were 85.9% (55/64), 89.1% (57/64) and 93.8% (60/64), respectively. Compared with exfoliated cytology (40.6%), The specificity of the four methods for the diagnosis of bladder cancer were 85.0% (17/20), 80.0% (16/20), 95.0% (19/20) and 95.0% (19 / 20). The sensitivity of UBC, HA and survivin in the diagnosis of bladder cancer was higher than that in urine cytology. There was no significant difference in the grade and stage of UBC (P> 0.05). The detected values of HA in G_2 and G_3 groups were significantly higher than those in G_1 group (P <0.01), but there was no significant difference between G_2 and G_3 groups (P> 0.05). There was no significant difference between the two groups (P> 0.05). There was no significant difference between survivin test grade and staging (P> 0.05). The urinary cytology, the higher the tumor grade, the higher the sensitivity (P <0.01), no significant difference between the staging (P> 0.05). The combined application of UBC, HA and survivin in the diagnosis of bladder cancer sensitivity and specificity of 100%. Conclusion The urinary UBC, HA and survivin are good tumor markers for early diagnosis of bladder cancer. The combination of 3 tests can improve the sensitivity and specificity of diagnosis.