三磷酸腺苷生物荧光法在表浅性膀胱尿路上皮癌个体化治疗中的临床应用

摘要

Objective:To investigate the application value of ATP-TCA (adenosine triphosphate-tumor chemotherapy assay) in superficial bladder transitional cell carcinoma for individualized treatment.Methods:The in vitro sensitivities of 35 cases of superficial bladder transitional cell carcinoma to 5 perfused drugs were assayed by ATP-TCA.All patients were given individualized treatment according to the results of ATP-TCA.Finally we valuated the relationship between prognosis and ATP-TCA by follow-ups.Results:The inhibition rates and in vitro sensitivities of different superficial bladder transitional cell carcinoma to 5 perfused drugs were obviously discrepant.The order of sensitive rates of 5 perfused drugs was THP (82.76％)＞EPI (50.00％)＞ADM (46.67％)＞HCPT (37.14％)＞MMC (17.14％).The result fo Chi-square test showed that the in vitro sensitivity of THP was significantly higher than those of the other four perfused drugs (P＜0.01).The difference was not statistically significant between the 30 incipient patients and the 5 recurrent patients to the 5 perfused drugs except THP (91.67％ vs 40.00％,P=0.033).During the follow-up period,there was 1 recurrence in the 30 incipient patients and there were 4 recurrences in the 5 recurrent patients.The difference of the recurrence rates was statistically significant between the incipient and recurrent patients (3.33％ vs 80.0％,P=0.000).Conclusion:ATP-TCA can provide a laboratory basis for the individualized treatment of superficial bladder transitional cell carcinoma,especially for incipient patients.It's worth of widespread clinical applications.%目的:探讨三磷酸腺苷生物荧光法在指导表浅性膀胱尿路上皮癌患者个体化治疗中的应用价值.方法:采用ATP-TCA测定35例表浅性膀胱尿路上皮癌对临床常用5种灌注药物的体外敏感性,并根据药敏结果进行个体化治疗,通过随访评价其预后与ATP-TCA的相关性.结果:不同个体的表浅性膀胱尿路上皮癌对5种灌注药物在不同浓度下均显示出明显的个体差异.5种灌注药物的敏感率依次为THP (82.76％) ＞EPI (50.00％) ＞ADM (46.67％) ＞HCPT(37.14％)＞MMC(17.14％),经卡方检验THP的敏感率显著高于其他4种灌注药物(P＜0.01).30例初发患者和5例复发患者除对THP的敏感率有显著性差异(91.67％ vs 40.00％,P=0.033)外,对其他灌注药物的敏感率均没有统计学差异(P＞0.05).随访期间,30例初发患者中有1例复发,5例复发患者中有4例复发,初发患者的复发率显著低于复发患者(3.33％ vs 80.0％,P=0.000).结论:ATP-TCA可作为表浅性膀胱尿路上皮癌患者个体化治疗的实验室依据,特别是对初发患者更有指导意义,值得在临床推广应用.