国际妇产科学杂志

国际妇产科学杂志 ›› 2010, Vol. 37 ›› Issue (6): 444-447.

• 论著 • 上一篇    下一篇

hTERC基因表达在宫颈病变诊治中的应用

李一冰， 乌兰娜 ，柳双燕， 刘志红 ，李鹃， 王 纯， 周艳秋 ，魏丽惠， 吴瑞芳   

  1. 518036 深圳，北京大学深圳医院妇产科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2010-12-15 发布日期:2010-12-15
  • 通讯作者: 吴瑞芳

The Application of hTERC Gene Amplification in Diagnosis and Treatment of Cervical Lesions

LI Yi-bing，WULAN Na，LIU Shuang-yan，LIU Zhi-hong，LI Juan，WANG Chun，ZHOU Yan-qiu，WEI Li-hui，WU Rui-fang   

  1. Department of Obstetrics and Gynecology of Peking University Shenzhen Hospital，Shenzhen 518036，China［LI Yi-bing（now working at Department of Obstetrics and Gynecology of Women’s and Children’s Shenzhen Hospital），WULAN Na，LIU Shuang-yan，LIU Zhi-hong，LI Juan，WANG Chun，ZHOU Yan-qiu，WU Rui-fang］；Department of Obstetrics and Gynecology of Peking University People’s Hospital，Beijing 100044，China（WEI Li-hui
  • Received:1900-01-01 Revised:1900-01-01 Published:2010-12-15 Online:2010-12-15
  • Contact: WU Rui-fang

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摘要： 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。

关键词: 宫颈上皮内瘤样病变, 宫颈肿瘤, 原位杂交, 荧光, 人乳头瘤病毒, 人端粒酶RNA组分

Abstract: Objective：To investigate the amplification of hTERC gene in the cervical exfoliated cells，explore its value in diagnosis and treatment of cervical intraepithelial neoplasia（CIN）. Methods：724 women were examined with liquid-based cytology, high-risk human papillomavirus（HR-HPV） testing using hybrid capture Ⅱ（HC-Ⅱ） and hTERC gene detection using fluorescence in situ hybridization（FISH） in Peking University Shenzhen Hospital. The patients with ASCUS and above lesion and/or positive HR-HPV results were examined by colposcopy，multiple biopsies of cervical quadrant and pathology. Results：The frequency of CIN Ⅰ,Ⅱ,Ⅲ，cervical cancer were 251（34.67%），17（2.35%），48（6.63%）and 10（1.38%） respectively in 724 patients， the rates of hTERC gene amplification was 11.05%. There was significant difference of hTERC amplification among the samples with different cytological and histological lesions and the HPV infection（P <0.01）. ①The positive rate of HPV infection in 724 patients was 39.64%；The positive rates of hTERC gene amplification were 19.86% in HPV positive and 5.26% in HPV negative （χ2=37.556，P ＜0.01）. ②In cytology，the rates of hTERC gene amplification were NILM（5.19%），ASCUS （10.23%），LSIL（11.84%），ASC-H（21.43%），HSIL （73.17%）， SCCA （100.00%），AGC（50.00%）；There was a marked increase of hTERC amplification in patients with HSIL and above lesion （χ2=186.755，P ＜0.01）. ③In histology，the rates of hTERC gene amplification were respectively normal（3.70%），CINⅠ（4.38%），CINⅡ（47.06%），CINⅢ（58.33%），invasive carcinoma（90.00%）. There was a marked increase of hTERC amplification in patients with CINⅡand above lesion（χ2=144.597，P ＜0.01）. Conclusion：There was a tight correlation between amplification of hTERC and the histological and cytological lesion. hTERC amplified or not may be as a prognostic indicator to judge whether high grade lesion or not.

Key words: Cervical intraepithelial neoplasia, Uterine cervical neoplasms, In situ hybridization, fluorescence, Human papillomavirus, Human telomerase RNA component