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目的探讨核仁组成区嗜银蛋白(AgNOR)在子宫内膜腺癌早期诊断与预后中的作用。方法采用银染法染色,检测子宫内膜增殖症25例,非典型增生内膜19例,子宫内膜腺癌63例,共107例为观察组;因患宫颈原位癌子宫切除后的正常子宫内膜组织25例为对照组;计数正常子宫内膜及不同内膜病变组织中单位细胞核内AgNOR的定量值,并对其进行形态学观察。结果AgNOR每核颗粒数在正常子宫内膜(2.51±1.97)、子宫内膜增殖症(2.92±2.02)、非典型增生内膜(3.04±2.05)间相比无统计学意义(P>0.05);在子宫内膜腺癌(7.43±2.18)中,AgNOR颗粒数明显升高,与良性病变组(子宫内膜增殖症、非典型增生内膜)及对照组相比有统计学意义(P<0.05);AgNOR颗粒计数与子宫内膜腺癌的分化程度[高分化(4.69±2.32)、中分化(5.38±2.99)、低分化(7.54±2.09)]、临床分期[Ⅰ期(3.68±3.16)、Ⅱ期(4.53±2.94)、Ⅲ期(7.27±2.84)、Ⅳ期(7.84±2.33)]、淋巴结转移[无转移(3.62±3.27)、有转移(7.68±2.42)]密切相关(P<0.05);AgNOR颗粒的形态分布随着子宫内膜病变的进展由单一型转变为弥散型。结论AgNOR的每核颗粒数及其形态分布与子宫内膜腺癌的发生、发展密切相关;检测AgNOR的定量值对早期诊断子宫内膜腺癌、判断疾病预后有一定的临床价值。
Objective To investigate the role of nucleolar organizer region AgNOR in the early diagnosis and prognosis of endometrial adenocarcinoma. Methods 25 cases of endometrial hyperplasia, 19 cases of atypical hyperplasia endometrium and 63 cases of endometrial adenocarcinoma were detected by silver staining. A total of 107 cases were treated as observation group. Because of the normal after uterine cervix carcinoma 25 cases of endometrial tissue as control group; counting normal endometrium and different endometrial tissue in the unit nucleus of AgNOR quantitative value, and its morphological observation. Results There was no significant difference in the number of nuclei per AgNOR between normal endometrium (2.51 ± 1.97), endometrial hyperplasia (2.92 ± 2.02) and atypical hyperplasia (3.04 ± 2.05) (P> 0.05) ; In endometrial adenocarcinoma (7.43 ± 2.18), the number of AgNOR particles was significantly higher than benign lesions group (endometrial hyperplasia, atypical hyperplasia endometrium) and the control group (P < 0.05). The difference between AgNOR particle count and the degree of differentiation of endometrial adenocarcinoma (well-differentiated (4.69 ± 2.32), moderately differentiated (5.38 ± 2.99), poorly differentiated (7.54 ± 2.09) (4.53 ± 2.94), stage Ⅲ (7.27 ± 2.84), stage Ⅳ (7.84 ± 2.33), lymph node metastasis (3.62 ± 3.27, metastasis (7.68 ± 2.42)], P <0.05). The morphological distribution of AgNOR particles changed from simple type to diffuse type with the progress of endometrial lesions. Conclusion The number of AgNOR particles per nucleus and their morphological distribution are closely related to the occurrence and development of endometrial adenocarcinoma. Detecting the quantitative value of AgNOR has certain clinical value in early diagnosis of endometrial adenocarcinoma and prognosis of the disease.