【摘要】 目的:探讨荧光原位杂交技术(FISH)检测人类染色体端粒酶(hTERC)基因在子宫颈病变中的表达和临床意义。方法:选取宫颈脱落细胞液基细胞学检查(TCT)为不典型鳞状细胞(ASC)及以上,行高危HPV检测及阴道镜下取活组织病理检查的87例患者为研究对象,用FISH技术检测脱落细胞hTERC基因扩增情况。结果:87例患者的hTERC基因异常扩增阳性率ASC组11.11%、LSIL 33.33%、HSIL 87.50%和SCC组100.00%,TCT检查为ASC及LSIL者hTERC基因异常扩增阳性率为23.81%明显低于HSIL及SCC者(91.11%),差异有统计学意义(P<0.01);71例高危型HPV感染患者的hTERC基因异常扩增阳性率为83.00%,而l6例HPV阴性患者为25.00%,差异有统计学意义(P<0.01);hTERC基因异常扩增阳性率炎症组为15.38%,CINⅠ组为28.00%,两者差异无统计学意义(P>0.05)。两组合并为宫颈低度病变组其hTERC基因异常扩增阳性率为23.68%明显低于CINⅡ/Ⅲ(77.55%)和浸润癌组(92.31%),差异有统计学意义(P均<0.01),CINⅡ/Ⅲ和浸润癌组比较差异有统计学意义(P<0.01)。hTERC基因平均扩增数炎症组(2.01±0.03)、CINⅠ组(3.23±1.20)、CINⅡ/Ⅲ组(9.58±7.24)、浸润癌组(39.24±18.61),宫颈低度病变组与CINⅡ/Ⅲ和浸润癌组相比差异有统计学意义(P<0.05)。高拷贝型hTERC基因构成率在CINⅡ/Ⅲ和浸润癌组明显增高(64.00%),与炎症和CINⅠ组(22.22%)相比差异亦有统计学意义(P<0.05)。对未行手术治疗的38例炎症~CINⅡ患者进行随访,有hTERC基因异常扩增的患者向高级别进展的比例为53.84%,无hTERC基因异常扩增的患者向高级别进展的比例为8.00%,差异有统计学意义(P<0.01)。结论:hTERC基因的异常扩增随宫颈病变级别增高而增加,在预测低级别宫颈病变是否会向高级别宫颈病变进展上有一定的价值,可以弥补TCT和高危HPV DNA检测的不足,可作为临床宫颈疾病筛查的一项重要的辅助检查。更多还原

【Abstract】 Objective: To explore the expression of hTERC gene detected by FISH in cervical lesions and the clinical significance.Methods: A total of 87 patients with ASC or above diagnosed by TCT and undergoing HPV test,colposcopic biopsy and pathological examination were selected as study objects,FISH technique was used to detect hTERC gene amplification in cervical cast- off cells. Results: The positive rates of hTERC gene abnormal amplification in ASC group,LSIL group,HSIL group and SCC group were 11. 11%,33. 33%,87. 50% and 100. 00%,respectively; among the patients diagnosed as ASC and LSIL by TCT,the positive rate of hTERC gene abnormal amplification was 23. 81%,which was statistically significantly lower than that among the patients diagnosed as HSIL and SCC( 91. 11%)( P <0.01); among 71 patients with high risk HPV infection,the positive rate of hTERC gene abnormal amplification was 83.00%,which was statistically significantly higher than that among 16 patients without HPV infection( 25. 00%)( P < 0. 01); the positive rates of hTERC gene abnormal amplification in inflammation group and CINⅠ group were 15. 38% and 28. 00%,respectively,there was no statistically significant difference between the two groups( P > 0. 05). The positive rate of hTERC gene abnormal amplification in low- grade cervical lesions group( inflammation and CINⅠ) was 23. 68%,which was statistically significantly lower than those of CINⅡ /Ⅲ group( 77. 55%)and SCC group( 92. 31%)( P < 0. 01),there was also statistically significant difference between CINⅡ /Ⅲ group and SCC group( P <0. 01). The average amplification numbers of hTERC gene in inflammation group,CINⅠ group,CINⅡ /Ⅲ group and SCC group were( 2.01 ±0.03),( 3.23 ±1.20),( 9.58 ±7.24) and( 39.24 ±18.61),respectively,there was statistically significant difference between low- grade cervical lesions group and CINⅡ /Ⅲ group,SCC group( P < 0. 05). The proportion of high- copy hTERC gene in CINⅡ /Ⅲgroup and SCC group increased significantly( 64. 00%),compared with inflammation group and CINⅠ group( 22. 22%),there was statistically significant difference( P < 0. 05). Thirty- eight patients with inflammation,CINⅠ and CINⅡ not receiving surgery were followed up,53. 84% of them with abnormal amplification of hTERC gene converted to high- grade cervical lesions,while the proportion in patients without abnormal amplification of hTERC gene was 8. 00%,there was statistically significant difference( P < 0. 01). Conclusion: Abnormal amplification rate of hTERC gene increases with increase of grade of cervical lesions,which has a certain value in predicting low- grade cervical lesions converting to high- grade cervical lesions or not; it can make up for the deficiencies of TCT and high risk HPV- DNA test,which can be used as an important assistant examination index for clinical screening of cervical lesions.更多还原