论文部分内容阅读
目的探讨人类染色体末端酶(hTERC)基因在宫颈不同病变脱落细胞中的扩增和临床意义。方法收集2008年1月—2009年5月来北京大学深圳医院宫颈门诊就诊的309例患者的宫颈脱落细胞标本,按细胞学分组分为未见上皮内瘤变(NILM)72例,未明确诊断意义的不典型鳞状细胞(ASC-US)71例、不除外高度上皮内病变的不典型鳞状细胞(ASC-H)19例、低度鳞状上皮内病变(LSIL)80例、高度鳞状上皮内病变(HSIL)49例和鳞状细胞癌(SCC)18例;按组织学分组分为正常或慢性宫颈炎33例、宫颈上皮内瘤变(CIN)Ⅰ级168例、CINⅡ/Ⅲ级84例和SCC组24例。用荧光原位杂交(FISH)方法检测宫颈脱落细胞中hTERC基因的扩增。结果在NILM、ASC-US、LSIL、ASC-H、HSIL和SCC中,hTERC基因扩增阳性率分别为5.56%、14.09%、15.00%、42.11%、67.35%、100%。在正常或慢性宫颈炎、CINⅠ级、CINⅡ/Ⅲ级和SCC中,hTERC基因扩增阳性率分别为6.06%、7.74%、54.76%、100%。随细胞学和组织学病变程度增加,hTERC基因扩增阳性率均增加(P<0.001)。hTERC基因在HR-HPV阳性与阴性组中扩增率为29.08%与11.11%,两组比较差异有统计学意义(P<0.05)。hTERC基因检测CINⅡ/Ⅲ级以上病变的敏感度、特异度、阳性预测值和阴性预测值分别为64.81%、92.54%、82.35%和83.04%。结论 hTERC基因扩增与宫颈细胞学和组织学异常密切相关,且随着病变程度增加其扩增阳性率增加,可作为预测宫颈癌前病变进展的生物遗传学标志物。
Objective To investigate the amplification and clinical significance of hTERC gene in exfoliated cells of different cervical lesions. Methods The specimens of cervical exfoliated cells from 309 patients who visited the cervical clinic of Peking University Shenzhen Hospital from January 2008 to May 2009 were divided into 72 cases without intraepithelial neoplasia (NILM) by cytology group, without definite diagnosis (ASC-US), 71 cases of atypical squamous cell (ASC-H) without high intraepithelial lesion, 80 cases of low grade squamous intraepithelial lesion (LSIL) 49 cases of HSIL and 18 cases of squamous cell carcinoma (SCC) .They were divided into three groups: normal or chronic cervicitis in 33 cases, cervical intraepithelial neoplasia (CIN) in grade I in 168 cases, CINⅡ / Ⅲ Grade 84 cases and SCC group 24 cases. Fluorescence in situ hybridization (FISH) was used to detect hTERC gene amplification in cervical exfoliated cells. Results The positive rate of hTERC gene amplification was 5.56%, 14.09%, 15.00%, 42.11%, 67.35% and 100% respectively in NILM, ASC-US, LSIL, ASC-H, HSIL and SCC. The positive rate of hTERC gene amplification was 6.06%, 7.74%, 54.76% and 100% in normal cervicitis, CINⅠgrade, CINⅡ / Ⅲscore and SCC respectively. With the increase of cytological and histological lesions, the positive rate of hTERC gene amplification increased (P <0.001). The amplification rates of hTERC gene in HR-HPV positive and negative groups were 29.08% and 11.11%, respectively. There was significant difference between the two groups (P <0.05). The sensitivity, specificity, positive predictive value and negative predictive value of hTERC gene were 64.81%, 92.54%, 82.35% and 83.04% respectively in CINⅡ / Ⅲlevel lesions. Conclusion The hTERC gene amplification is closely related to cervical cytology and histological abnormalities. The positive rate of hTERC gene amplification with the increase of lesion degree may be a biogenetic marker for predicting the progression of cervical precancerous lesions.