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目的:探讨人端粒酶RNA(hTERC)基因在宫颈病变筛查中的临床意义。方法:收集2008年1月～11月南华大学第一附属医院115例妇女宫颈脱落细胞标本,病理学检查确诊CIN患者69例,宫颈鳞癌(SCC)患者26例,正常细胞学妇女20例。用荧光原位杂交(FISH)方法检测脱落细胞hTERC基因的表达。结果:①hTERC基因在CINⅠ、CINⅡ、CINⅢ及SCC患者宫颈脱落细胞中的阳性表达率分别是22.00%、75.00%、100.00%和100.00%。CINⅠ、CINⅡ、CINⅢ和SCC组与正常组比较,hTERC基因阳性率差异有统计学意义(P<0.05)。其中CINⅠ与CINⅡ、CINⅢ比较,CINⅠ与SCC比较差异有统计学意义(P<0.05)。②随着病变程度增加,hTERC基因的表达率增加。在CINⅠ中hTERC基因扩增的异常细胞仅占6.5%,而在CINⅡ、CINⅢ及SCC患者宫颈脱落细胞中,hTERC基因扩增的异常细胞所占比例依次递增为25.50%、30.60%和50.80%(P<0.05)。FISH检测结果显示,CINⅠ组细胞中hTERC基因异常扩增信号为2∶3型占60.00%,而在SCC中仅占36.44%。SCC中,4∶4型和5∶5型所占比例最多,其中5∶5型拷贝数是各级CIN的总和。hTERC基因的表达水平与宫颈病变的程度关系密切。结论:hTERC基因在CIN和SCC中表达异常,且随病变程度增加阳性表达率增加,可作为宫颈癌前病变进展的生物遗传学检测指标。
Objective: To investigate the clinical significance of human telomerase RNA (hTERC) gene in screening cervical lesions. Methods: A total of 115 cases of cervical exfoliated cells were collected from the First Affiliated Hospital of Nanhua University from January 2008 to November 2008. Totally 69 CIN patients diagnosed by pathology, 26 cervical squamous cell carcinoma (SCC) and 20 normal cytology women were collected. The expression of hTERC gene in exfoliated cells was detected by fluorescence in situ hybridization (FISH). Results: ① The positive rates of hTERC gene expression in cervical exfoliated cells of CINⅠ, CINⅡ, CINⅢand SCC were 22.00%, 75.00%, 100.00% and 100.00% respectively. The positive rates of hTERC gene in CINⅠ, CINⅡ, CINⅢand SCC group were significantly different from those in normal group (P <0.05). Among them, the CINⅠcompared with CINⅡ and CINⅢ, the difference between CINⅠ and SCC was statistically significant (P <0.05). ② With the increased degree of disease, hTERC gene expression increased. In CINⅠhTERC gene amplification of abnormal cells accounted for only 6.5%, while in CIN Ⅱ, CIN Ⅲ and SCC patients with cervical exfoliated cells, hTERC gene amplification of the proportion of abnormal cells in turn increased as 25.50%, 30.60% and 50.80% ( P <0.05). The results of FISH showed that the signal of abnormal amplification of hTERC gene in CINⅠgroup was 60.00% in 2: 3 type and 36.44% in SCC. SCC, 4: 4 and 5: 5 accounted for the largest proportion, of which 5: 5 copy number is the sum of CIN at all levels. The expression level of hTERC gene is closely related to the degree of cervical lesions. CONCLUSION: The expression of hTERC gene in CIN and SCC is abnormal, and the expression of hTERC increases with the increase of the degree of lesion. It can be used as a biogenetic detection index for the progression of cervical precancerous lesions.