【作者】 彭东涛；

【导师】 苟欣；

【作者基本信息】 重庆医科大学 ， 外科学， 2002， 硕士

【摘要】 目的：探讨MMP~9、MMP~2、及PCNA在膀胱移行细胞癌中的表达及临床意义。方法：采用免疫组织化学S－P法检测64例人膀胱移行细胞癌石蜡切片中MMP~9、MMP~2及PCNA的表达。结果：64例膀胱移行细胞癌中，MMP~9、MMP~2及PCNA的阳性表达率分别为60.93％(39/64)、42.19％(27/64)、56.25%(36/64)；其中呈高表达者MMP9为26例、MMP2为14例、PCNA为24例，高表达率分别为21.88%(14/64)、40.63%(26/64)、37.5％(24/64)。在G~1、G~2、G~3三组中，MMP~2的阳性表达率分别为27.78%(5/18)、40％(10/25)、57.14%(12/21)，MMP~9的阳性表达率分别为27.78%(5/18)、60%(15/25)、90.48％(19/21)，PCNA的阳性表达率分别为22.22%(4/18)、56%(14/25)、85.71%(18/21)。三组间比较及三组间两两比较，MMP~2的表达没有显著性差异(P＞0.05) ,MMP~9及PCNA的表达均有显著性差异（P＜0.05）。<WP=8>在Tis－T~1、T~2－T~4两组中，MMP~2的阳性表达率分别为22.86%（8/35）、65.52％（19/29）；MMP~9和PCNA的阳性表达率分别为：42.86%（15/35）、82.76%（24/29）;34.29%（12/35）、82.76%（24/29）。两组间比较，MMP~ 9和PCNA的表达均有显著性差异（P＜0.01）,而MMP~2的表达无显著性差异。64例标本中MMP~9、PCNA同时呈现阳性表达和同时呈现阴性表达各占45.31%（29／65）、28.13% (18／64)，两者表达具有相关性。获随访资料的27例患者（平均随访时间3年）中，肿瘤复发10例。MMP~9和PCNA阳性表达组的肿瘤复发率分别为57.14%(8/14)、56.25%(9/16)，阴性表达组的肿瘤复发率分别为15.38%(2/13)、9.09%(1/11)。两者间比较有显著性意义（P<0.05）。MMP~9、PCNA高表达多见于病理分级高、临床分期晚及复发的病例。结论：MMP~9、PCNA的表达随膀胱移行细胞癌的病理分级、临床分期增加，而呈上升趋势。MMP~9或PCNA阳性表达者较阴性表达者，其肿瘤复发的可能性更大，预后差；MMP~9表达和PCNA表达具有相关性。对膀胱移行细胞癌MMP~9和PCNA的表达情况进行分析，可以估计肿瘤的恶性程度、判断患者的预后。对选择恰当的术后综合治疗方案具有一定的指导意义。更多还原

【Abstract】 Objectives: To elucidate the effect of expression of MMp~9, MMp~2 and PCNA in transition cell carcinoma of bladder (TCCB).Methods: The immunohistochemical staining with S-P method was used to detect the expression of MMP~9, MMP~2 and PCNA in 64 paraffin sections of human TCCB tissues.Results: The expression rates of MMP~9, MMP~2 and PCNA were respectively 60.93%, 42.19% ,56.25% , and their high expression rates were 40.63%(26/64),21.88%(14/64) and 37.50%(24/64) respectively. The expression rate of the MMP~2 was 27.78（5/18）% of G~1 , 40%（10/25） of G~2 , 57.14%（12/21）of G~3 , 22.85%（8/35）of Tis-T1 and 65.52%（19/29） of T2-T4 tumors respectively. There was no significant difference either among G~1, G~2, G~3(p>0.05) or between Tis-T~1 and T~2-T~4(p>0.05). The expression rate of the MMP~9 was 27.78%（5/18）of G~1, 60%（15/25）of G~2, 90.48%（19/21）of G~3, 42.86%（15/35）of Tis-T~1 and 82.76%（24/29）of<WP=5>T~2-T~4 tumors respectively and that of the PCNA was 22.22%（4/18）of G~1, 56%（14/25）of G~2, 85.71%（18/21）of G~3, 34.29%（12/35） of Tis-T~1 and 82.76%（24/29）of T~2-T~4 tumors. There were significant differences either among G~1, G~2, G~3 or between Tis-T~1,T~2-T~4(p<0.05 or p<0.01). The expression rate of concomitantly positive between MMP~9 and PCNA was 45.31%(29/65) and the expression rate of concomitantly negative between MMP~9 and PCNA was 28.13%(18/64). The correlation between MMP~9 and PCNA expression was significant (p<0.01).Average three years follow-up was obtained in 27 patients. The recurrence rate was 57.14%(8/14) of positive MMP~9 expression team and 15.38%(2/13)of negative MMP~9 expression team. There was a significant difference between positive MMP~9 expression team and negative MMP~9 expression team(p<0.05). The recurrence rate was 56.25%(9/16) of positive PCNA expression team and 9.09%(1/11)of nagative PCNA expression team. There was a significant difference between positive PCNA expression team and negative PCNA expression team(p<0.05). There was no significant correlations between MMP~9 expression and patient age,sex, the number of tumor (p>0.05),nor was PCNA. The high expression of MMP~9 or PCNA most likely appeares in high pathological grade, later clinical stage and recurrent cases .Conclusions: The expression of either MMP~9 or PCNA tended to<WP=6>increase with the tumor grade and stage, which was significantly correlated with recurrence and prognosis of TCCB. The correlation between MMP~9 and PCNA expression was significant. MMP~9 or PCNA appears to be an independent biological marker for predicting malignancy and prognosis of TCCB, so the concomitant detection of MMP~9 and PCNA have a practical value in selecting comprehensive treatment of TCCB.更多还原