葛含天　王达飞

[摘要] 目的 分析小細胞肺癌（SCLC）者循环肿瘤细胞（CTC）检测的应用价值情况。方法 便利选择2013年12月—2016年12月宝应县人民医院收治的288例SCLC者为研究对象，另取健康体检者70名，良性疾病组56例为对照者。使用免疫磁珠阴性富集和免疫荧光化学染色法，分析静脉血内CD45-/CTC/CK18+数量，随访104例化疗者，分析SCLC者CTC检测价值。结果 和良性疾病者（3.57%）以及对照组（5.71%）相比，SCLC组（64.58%）的CTC检查结果差异有统计学意义（P<0.05）。对照组中CTC阳性率为5.7%，SCLC者临床分期IIIA，IIIB和IV期阳性率分别为32.1%，56.9%以及78.1%。组间数据差异有统计学意义（P<0.05）。经单变量分析证实，肿瘤T和N分期与CTC阳性无相关性，远处转移与其结果呈正相关（P<0.05）。阴性富集肿瘤回收率为92.0%，阳性对照细胞株H460和A549经荧光抗体染色后上述两种细胞株中存在细胞角蛋白CK18以及CK19。肺癌者敏感性以及特异性为98.2%以及72.9%。调查区间内生存者共计248例CTC数量为2～4个，无显著上升，其临床特征为CTC阳性全身多发性转移，PS分数低。结论 该实验所使用的检测方式简便可行，特异性和敏感性较高，CTC阳性和疾病分期，是否吸烟，治疗效果和转移呈现相关性，CTC越高，证实患者预后不良

[关键词] CTC；角蛋白18相关抗原；免疫磁珠

[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2017）08（a）-0046-03

[Abstracts] Objective This paper tries to analyze the application value of circulating tumor cells（CTC） inspection on small cell lung cancer（SCLC）. Methods 288 cases of SCLC from December 2013 to December 2016 in Baoying People's hospital were selected， 70 cases of healthy physical examination， 56 cases of benign disease as the control group. the number of venous CD45-/CTC/CK18+， CTC detection value of SCLC among the follow-up of 104 cases of chemotherapy were analyzed through negative immune magnetic beads enrichment and immunofluorescence chemical dyeing method. Results CTC test results of benign disease was 3.57% and that of the control group was 5.71%， SCLC group was 64.58%， and there were statistical differences（P<0.05）. CTC positive rate was 5.7% in control group， positive rate of the clinical stage IIIA， stage IIIB and IV of the SCLC group were 32.1%， 56.9% and 78.1%. There was difference between the groups （P<0.05）. Confirmed by univariate analysis， there was no correlation between the tumor T and N stage and CTC positive， and there was positively correlation between distant metastasis and its results（P<0.05）. Negative enrichment tumor recovery was 92.0%， the positive control cell line A549 and H460 by fluorescent antibody staining of the above two kinds of cell lines existed cytokeratin CK18 and CK19. Sensitivity and specificity of lung cancer was 98.2% and 72.9% respectively. Among the 248 cases of survivals CTC number were 2 to 4， with no significant increase， and with the clinical features of multiple transfers of CTC positive， and low PS score. Conclusion Inspection method in this study is simple and feasible， high specificity and sensitivity. There is correlation between the CTC positive and disease staging， smoking， treatment effect and transfers， the higher the CTC is， the poor condition of the patients have.endprint

[Key words] CTC； Keratin 18 related antigen； Immunemagnetic beads

现如今，我国的肺癌发生率已经跃居世界之首[1-2]。当癌细胞进入到血液循环之后，一般经过免疫系统以及血液流动学转移，极少数肿瘤细胞会随着血液的流动而形成转移病灶。循环肿瘤细胞（CTC）在机体内水平代表了癌细胞血性转移水平，CTC在检测SCLC疾病的在早期诊断，监控复发转移以及判断预后结果等方面，均具有一定临床意义。结合实际情况，该文便利选择2013年12月—2016年12月该院收治的288例SCLC者为研究对象，并设立对照组以及良性肺部疾病组，全面分析该疾病患者的CTC检测应用价值情况，现报道如下。

1 资料与方法

1.1 一般资料

该文便利选择该院收治的288例SCLC者为研究对象，另取健康体检者70名，良性疾病组56例为对照者。

1.2 方法

①样本收集：使用真空采血管，收集病患肘部正中静脉血。为避免静脉穿刺过程内发生上皮细胞污染，不收集前2 mL血。收集后7.5 mL血液，后分别放置在ACD抗凝管内。②磁珠富集：将收集好的血液在48 h内完成CD45磁珠富集环节。……