hTERC和HPV联合检测在宫颈上皮内瘤变筛查中应用  

A clinical investigation on detection of hTERC and HPV-DNA for cervical intraepithelial neoplasia screening

作　　者：梅佳[1] 李桂梅[1] 杨志慧[1] 

机构地区：[1]解放军第八一医院病理科,南京210002

出　　处：《临床与实验病理学杂志》2011年第9期947-950,共4页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的观察人端粒酶mRNA基因(human telomerase mRNA componentgene,hTERC)在宫颈上皮内瘤变(cervical intraepi-thelial neoplasia,CIN)及宫颈癌中的表达情况,探讨其作为宫颈病变筛查的临床意义。方法收集135例宫颈疾病患者的宫颈活检组织标本。根据组织学结果分组,其中正常组(包括炎症患者)24例;CIN组100例,其中CIN 1级30例,CIN 2级50例,CIN 3级20例;宫颈癌(鳞癌)组11例。采用双色间期FISH技术检测宫颈细胞hTERC基因扩增情况,同时其中的85例患者进行了HPV-DNA检测,阳性者49例,阴性者36例。结果 (1)hTERC基因在正常组、CIN组及宫颈癌组中的阳性表达率分别为4.2%、38.0%和90.9%,各组间差异有统计学意义(P<0.01),与病变程度呈正相关(r=0.419,P<0.01)。(2)hTERC基因在CIN 1～3级组中的阳性表达率分别为10.0%、48.0%和55.0%,CIN 2级组与CIN 3级组比较差异无统计学意义(P>0.05),CIN 1～3级组间比较差异有统计学意义(P<0.01),与病变的恶性程度呈正相关(r=0.354,P<0.01)。(3)49例HPV阳性患者中,hTERC基因扩增阳性率为57.14%(28/49);而在36例HPV阴性患者中,hTERC基因扩增阳性率为25.0%(9/36),两者差异比较有统计学意义(P<0.005),同时hTERC基因的扩增情况与HPV感染情况两者间呈正相关(r=0.320,P<0.003)。结论 hTERC基因的阳性率随宫颈病变级别的升高而增加,可预测病变的进展情况。hTERC基因的扩增和HPV感染呈正相关,提示HPV的感染可能是hTERC基因异常扩增的早期事件。HPV-DNA和hTERC基因联合检测相结合是宫颈CIN早期筛查的理想手段。Purpose To investigate the expression of the human telomerase mRNA componentgene（hTERC） in cervical intraepithelial neoplasia（CIN） and cervical cancer,and to evaluate the clinical screening significance of hTERC in cervical lesions.Methods The fluorescence signal of histologic samples of cervix were detected by using interphase FISH inchromosome enumeration double-color DNA probes TERC.According to the histology biopsy,135 specimens were divided into normal group（n=24）,cervical intraepithelial neoplasia group（CIN,n=100） and carcinomas of the cervix group（n=11）.Among this 85 cases who received HPV-DNA examination,49 were positive and 36 were negative.Results（1） Positive expression of the hTERC gene in normal group,CIN and cervical cancer were 4.2%,38.0% and 90.9%（P0.01）.There was obviously positive correlation between hTERC expression rate and the degree of disease（r=0.419,P0.01）.（2） Positive expression of the hTERC gene in CIN 1,CIN 2 and CIN 3 were 10.0%,48.0% and 55.0%,there was statistically significant difference among CIN 1,CIN 2 and CIN 3（P0.01）,which no difference among CIN 2 and CIN 3（P0.05）.There was obviously positive correlation between hTERC expression rate and the degree of disease（r=0.354,P0.01）.（3） Amplification of hTERC gene in 49 cases with HPV infected was significant more than that in the 36 cases without HPV infection（57.14% vs 25%,P0.005）.Conclusion The positive rate of hTERC gene increased with the cervical lesion grade which makes it a screening test marker for CIN 2/3 and may help to determine the progressive potential of individual lesions.The gain of hTERC gene may be an early stage event which related to the activation of telomerase resulted from HPV infection.The detection of HPV-DNA and hTERC can be used as an ideal tumor index for early cervical intraepithelial neoplasia screening.

关 键 词：子宫颈肿瘤 宫颈上皮内瘤变 荧光原位杂交 人类染色体端粒酶 HPV 

分 类 号：R737.33[医药卫生—肿瘤]