用石蜡切片检测端粒酶RNA基因对诊断与鉴别子宫颈上皮内瘤变1级与2级的意义  

The significance of differential diagnosis of detection of TERC gene by FISH technique in paraffin section between CIN1 and CIN2

作　　者：何春年[1] 徐明堂[1] 荀文娟[1] 

机构地区：[1]河北省人民医院病理科,石家庄市050051

出　　处：《河北医药》2014年第24期3685-3688,共4页Hebei Medical Journal

基　　金：河北省自然科学基金项目(编号:H2012307001)

摘　　要：目的探讨在石蜡切片上用FISH技术检测TERC基因对诊断鉴别诊断CIN 1级与CIN 2级的实用意义。方法选取手术切除及活检的子宫颈组织,有效样本137例,其中正常宫颈鳞状上皮组20例,CIN 1级组46例,CIN 2级组49例,HE染色难以确定CIN 1/CIN 2级组22例。采用FISH技术在石蜡包埋组织上检测TERC基因拷贝数增加的情况。结果正常宫颈鳞状上皮中无TERC基因拷贝数的增加,CIN 1级组中TERC基因扩增率15.2%(7/46),CIN 2级组中TERC基因扩增率47%(23/49),并且出现大量的三倍体、四倍体及非整倍体扩增,2组之间差异有统计学意义(P<0.05)。CIN 1/CIN 2级组中TERC基因扩增率27.8%(5/22)。组间两两比较:正常宫颈鳞状上皮组与CIN 1级组组间比较差异无统计学意义(P>0.05);正常宫颈鳞状上皮组与CIN 2级组组间比较差异有统计学意义(P<0.05);CIN 1级组与CIN 2级组组间比较差异有统计学意义(P<0.05)。TERC基因扩增在鉴别CIN 1级与CIN 2级中的敏感度为46.9%,特异度为84.7%,准确度为65.0%,阳性预测值为76.6%,阴性预测值为60%。结论当组织学上鉴别CIN 1级与CIN 2级有困难时,在石蜡包埋组织切片上应用FISH技术检测TERC基因,发现拷贝数增加可有助于CIN 2级的确诊,也预测其有恶性进展的风险;反而无TERC基因异常,可确认为CIN1级,无恶性进展风险。TERC基因检测具有实用价值及应用前景。Objective To investigate the practical significance of detection of telomerase RNA gene （ TERC ） by FISH technique in paraffin section in differential diagnosis between grade 1 cervical intraepithelial neoplasia （CIN1） and grade 2 cervical intraepithelial neoplasia （CIN2）.Methods The 137 specimens of cervical tissue from surgical ablation or biopsy were enrolled in the study in which there were 20 cases of normal cervical squamous epithelium tissues ,46 cases of CIN1,49 cases CIN2 and 22 cases of CIN1/CIN2 that were difficult to be identified by HE staining .The TERC gene amplification status was detected by FISH method in paraffin section .Results The increase of TERC gene copy number was not found in normal cervical squamous epithelium .TERC gene amplification rate was 15.2%（7/46） in CIN1,47%（23/49） in CIN 2,27.8%（5/22） in CIN1/CIN2,respectively.There were significant differences between any two groups （ P〈0.05）.There was no significant difference in TERC gene amplification rate between normal cervical squamous epithelium and CIN 1（ P〉0.05）, however,there was a significant difference between normal cervical squamous epithelium and CIN 2 （ P〈0.05）,moreover, there was a significant difference between CIN 1 and CIN2 （ P〈0 .05 ） .The sensitivity of TERC gene amplification in differential diagnosis between CIN1 and CIN2 was 46.9%, specificity was 84.7%, accuracy was 65.0%, and positive predictive value was 76 .6%, negative predictive value was 60%.Conclusion The detection of TERC gene by FISH technique in paraffin section for differential diagnosis between CIN 1 and CIN2 is feasible and reliable , which has practical value and wide application prospect .

关 键 词：子宫颈上皮内瘤变 FISH检测 TERC基因 基因拷贝数 

分 类 号：R730.4[医药卫生—肿瘤]