【作者】 周敏；

【导师】 冷维春； 田秀娟；

【作者基本信息】 吉林大学 ， 临床科学， 2013， 硕士

【摘要】 子宫内膜癌被认为是女性常见的三大生殖道恶性肿瘤之一，约占妇科恶性肿瘤的20%-30%。子宫内膜样腺癌约占子宫内膜癌的80%，20年来发病率明显上升。近年来，随着饮食结构改变、外源性雌激素的广泛应用、人均寿命延长、节育等因素，子宫内膜样腺癌的发病率呈逐年上升趋势，严重影响着妇女的健康。近年来，分子生物学迅速发展，肿瘤的恶性程度及其临床预后的判读越来越依赖于多基因表达及其相关性分析，这使得影响细胞增殖、分化以及癌变的相关基因越来越受到关注，而对于它们在肿瘤发生、发展中的研究也越发受到重视，因此分子水平上的肿瘤发生和发展的研究已经成为了热点课题。AQP1具有转运水和离子的功能,另外，AQP1对细胞内外气体交换、细胞迁移及肿瘤血管的生成有作用，使其成为研究的热点。nm23-H1与肿瘤转移密切相关，成为了临床研究中的热点。本研究利用免疫组织化学方法检测AQP1和nm23-H1在正常的子宫内膜组织中、单纯性及复杂性增生的子宫内膜组织中、非典型增生的子宫内膜组织中以及子宫内膜样腺癌组织中的表达情况，探讨其在子宫内膜样腺癌的发生、发展以及预后中的作用，为子宫内膜样腺癌的早期诊断、治疗以及病情评估和预后评价提供参考依据。结果发现：在子宫内膜样腺癌中AQP1的阳性表达显著高于其在其正常的子宫内膜组织中、单纯性及复杂性增生的子宫内膜组织中及非典型增生的子宫内膜组织中的阳性表达，且随着子宫内膜样腺癌手术-病理分期越晚、病理分级越低、肌层浸润深度越深，其阳性表达率越高，有淋巴结转移的子宫内膜样腺癌中AQP1的阳性表达显著高于无淋巴结转移的。在子宫内膜样腺癌中nm23-H1的阳性表达显著低于其在其正常的子宫内膜组织中、单纯性及复杂性增生的子宫内膜组织中及非典型增生的子宫内膜组织中的阳性表达，且随着子宫内膜样腺癌手术-病理分期越晚、病理分级越低、肌层浸润深度越深，其阳性表达率越低，有淋巴结转移的子宫内膜样腺癌中nm23-H1的阳性表达显著低于无淋巴结转移的。子宫内膜癌的发病机制是多元的，AQP1和nm23-H1只是其中之一，研究和检测AQP1和nm23-H1有可能成为筛查子宫内膜癌高危因素的指标，有望成为判断子宫内膜癌恶性程度及基因治疗的位点。更多还原

【Abstract】 Objective: The goal of this article is to research AQP1andnm23-H1protein detected by immunohistochemistry in normalendometrium, simple and complex hyperplasia, atypical endometrialhyperplasia and endometrial adenocarcinoma and research the expressionlevel in different tissues above situation with histopathological grading,surgical-pathologic stage, myometrial relationship between the depth ofinvasion, and lymph node metastasis by statistical test method. Exploreits role in the occurrence, development and prognosis of endometrialadenocarcinoma, and to provide a reference for the early diagnosis ofendometrial adenocarcinoma, treatment and condition assessment andprognostic evaluation.Methods: Selected the tissue specimens by surgical resection in The China-Japan Union Hopsital of Jilin University between September2010and September2012. Select the specimen were freshly drawnimmediately fixed in10%neutral formalin solution, paraffin embedded.Slice4μm thick, stained by HE,AQP1and nm23-H1immunohistochemical staining. Positive control for known positivesections contained in the kit, pathologists identified all slices by blinded,immunohistochemistry staining tissue to detection AQP1and nm23-H1expression.Results:1. AQP1protein positive particles brownish yellow, locatedin the cell membrane and (or) nucleus. The positive expression of AQP1in Group1, Group2, Group3, Group4, Group5is6.7%,10.0%,13.3%,16.7%,37.9%. Compared among the five groups,χ2=17.751, P<0.01，there was a significant statistical difference. AQP1protein expression was significantly elevated in endometrialadenocarcinoma, there was a statistically significant difference comparedwith the remaining four groups, the results were χ2=9.744, χ2=7.584,χ2=5.747, χ2=4.204, P＜0.05. Compared among1-4Group, χ2=1.617, P ＞0.05, there was no significant difference or statistically significant,.2. nm23-H1protein positive particles brownish yellow, located inthe nucleus. The positive expression of nm23-H1in Group1, Group2,Group3, Group4, Group5is73.3%,66.7%,56.7%,50.0%,34.5%.Compared among the five groups, χ2=15.876, P<0.01， there was asignificant statistical difference. AQP1protein expression wassignificantly lower in endometrial adenocarcinoma, there was astatistically significant difference compared with the remaining fourgroups, the results were χ2=11.962, χ2=8.261, χ2=5.274, χ2=3.993, P＜0.05. Compared among1-4Group, χ2=2.138, P＞0.05, there was nosignificant difference or statistically significant.3. The positive expression rate of AQP1protein in surgical stage Iand II~III were27.5%,61.1%. Compared between the two group,χ2=5.957, P＜0.05, there was a significant statistical difference. Thepositive expression rate of AQP1protein in histopathological grading G1and G2+G3were23.3%,53.6%. Compared between the two group,χ2=5.625, P＜0.05, there was a significant statistical difference. The positive expression rate of AQP1protein in≤1/2depth of myometrialinvasion and＞1/2depth of myometrial invasion were25.0%,59.1%.Compared between the two group, χ2=6.741, P＜0.05, there was asignificant statistical difference. The positive expression rate of AQP1protein in without lymph node metastasis and lymph node metastasiswere26.7%,66.7%. Compared between the two group, χ2=5.815, P＜0.05, there was a significant statistical difference.4. The positive expression rate of nm23-H1protein in surgical stageI and II~III were45.9%,11.1%. Compared between the two group,χ2=6.310, P＜0.05, there was a significant statistical difference. Thepositive expression rate of nm23-H1protein in histopathological gradingG1and G2+G3were50.0%,17.9%. Compared between the two group,χ2=6.623, P＜0.05, there was a significant statistical difference. Thepositive expression rate of nm23-H1protein in≤1/2depth of myometrialinvasion and＞1/2depth of myometrial invasion were44.4%,18.2%.Compared between the two group, χ2=4.169, P＜0.05, there was asignificant statistical difference. The positive expression rate of nm23-H1 protein in without lymph node metastasis and lymph node metastasiswere43.2%,8.3%. Compared between the two group, χ2=4.725, P＜0.05,there was a significant statistical difference.Conclusion:1. AQP1expression may promote the development ofendometrial adenocarcinoma.2. nm23-H1low expression may promote the development ofendometrial adenocarcinoma.3. High expression of AQP1may indicate a high degree ofmalignancy and invasion intensity.4. Low expression of nm23-H1may indicate a high degree ofmalignancy and invasion intensity.更多还原