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目的:探讨宫颈脱落细胞中hTERC的基因表达在宫颈上皮内瘤样病变(CIN)诊断与治疗中的应用。方法:抽取行子宫颈癌筛查的724例妇女为研究对象,对其同步进行宫颈脱落细胞的液基细胞学检查、第二代杂交捕获技术(HC-Ⅱ)检测高危型HPV(HR-HPV)和荧光原位杂交(FISH)技术检测hTERC基因。对于细胞学为未明确诊断意义的不典型鳞状上皮细胞(ASCUS)及以上病变,和(或)HR-HPV阳性者均行阴道镜下宫颈四象限多点活检进行病理诊断。结果:724例中经病理确定为CINⅠ,Ⅱ,Ⅲ及子宫颈癌者分别为251例(34.67%)、17例(2.35%)、48例(6.63%)和10例(1.38%),宫颈脱落细胞hTERC的扩增率为11.05%。①724例HPV阳性率为39.64%;hTERC扩增在HPV阳性与阴性组分别为19.86%与5.26%(χ2=37.556,P<0.01)。②hTERC扩增在细胞学无宫颈上皮内瘤变(NILM)组为5.19%、ASCUS为10.23%、低度鳞状上皮内瘤样病变为(LSIL)11.84%、非典型鳞状上皮细胞-不除外高度鳞状上皮内瘤变(ASC-H)为21.43%、高度鳞状上皮内瘤样病变(HSIL)为73.17%、鳞状细胞癌(SCCA)为100.00%、非典型腺上皮细胞(AGC)为50.00%;hTERC在HSIL及以上病变中的扩增率明显高于LSIL及以下病变(χ2=186.755,P<0.01)。③在不同组织学结果中hTERC的扩增率分别为,NILM 3.70%、CINⅠ4.38%、CINⅡ47.06%、CINⅢ58.33%、浸润癌90.00%,hTERC在CINⅡ及以上级别病变中的扩增率明显高于CINⅠ和NILM者(χ2=144.597,P<0.01)。结论:hTERC的扩增与宫颈细胞学和组织学异常密切相关,hTERC扩增与否有可能作为判断有无高度病变及估计预后的指标之一。
Objective: To investigate the gene expression of hTERC in cervical exfoliated cells in the diagnosis and treatment of cervical intraepithelial neoplasia (CIN). Methods: A total of 724 women who underwent cervical cancer screening were enrolled in this study. Liquid-based cytology examination of exfoliated cervical cells was performed simultaneously. The second generation hybridization capture technique (HC-Ⅱ) ) And fluorescence in situ hybridization (FISH) detection of hTERC gene. Cervical four-quadrant multipoint biopsy was performed for histopathological diagnosis of atypical squamous cells (ASCUS) and above with pathologically undetermined diagnostic significance and / or HR-HPV positive. Results: Among the 724 cases, 251 cases (34.67%), 17 cases (2.35%), 48 cases (6.63%) and 10 cases (1.38%) were diagnosed as CINⅠ, Ⅱ, Exfoliated cells hTERC amplification rate was 11.05%. ① The positive rate of HPV in 724 cases was 39.64%. The hTERC amplification in HPV positive and negative groups was 19.86% and 5.26% respectively (χ2 = 37.556, P <0.01). ② The hTERC amplification was 5.19% in cytological non-cervical intraepithelial neoplasia (NILM) group, 10.23% in ASCUS, and 11.84% in low-grade squamous intraepithelial neoplasia (LSIL). The atypical squamous epithelial cells The high grade squamous intraepithelial neoplasia (ASC-H) was 21.43%, the high grade squamous intraepithelial neoplasia (HSIL) was 73.17%, the squamous cell carcinoma (SCCA) was 100.00%, the atypical glandular epithelial cells (AGC) Was 50.00%. The hTERC amplification rate in HSIL and above lesions was significantly higher than those in LSIL and below lesions (χ2 = 186.755, P <0.01). ③ The hTERC amplification rates in different histological findings were as follows: NILM 3.70%, CINⅠ4.38%, CINⅡ47.06%, CINⅢ58.33%, invasive carcinoma 90.00%, hTERC in CINⅡ and above lesions Rates were significantly higher than CIN I and NILM (χ2 = 144.597, P <0.01). Conclusion: The amplification of hTERC is closely related to cervical cytology and histological abnormalities. Whether hTERC is amplified or not may be one of the indicators to judge whether there is a high degree of disease or not and to estimate the prognosis.