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目的探讨叶酸受体(FR)α在高度鳞状上皮内病变(HSIL)及早期宫颈鳞癌(SCC)组织中的表达及在提高HSIL检出率中的意义。方法采用快速冰冻免疫组化法检测2014年11月至2015年4月在山西医科大学第二医院妇科门诊经阴道镜宫颈组织病理证实的21例HSIL、30例早期SCC及正常宫颈组织30例(对照组)中FRα的表达。并对这些病例进行人乳头瘤病毒(HPV)和液基薄层细胞学(TCT)检查。结果在对照组、HSIL组和SCC组中,FRα阳性表达率依次为26.7%、85.7%、76.7%,3组间差异有统计学意义(χ2=19.368,P<0.001)。其中,HSIL、SCC组FRα阳性表达率高于对照组(P<0.05);但HSIL和SCC组间差异无统计学意义(P>0.05)。FRα阳性者中HSIL的检出率(34.0%),与TCT阳性者中HSIL的检出率(33.3%)相当,高于HPV(27.4%);FRα快速冰冻免疫组化检测HSIL的灵敏度和特异度分别为76.2%和93.3%,受试者工作特征曲线(ROC)下面积为0.848,高于HPV、TCT。两两联合检测中以TCT串联FRα效果最佳。结论快速冰冻免疫组化检测FRα蛋白表达可作为客观的生物指标提高HSIL的检出率。
Objective To investigate the expression of folic acid receptor (FR) α in high grade squamous intraepithelial lesion (HSIL) and early cervical squamous cell carcinoma (SCC) and its significance in improving the detection rate of HSIL. Methods Rapid frozen-thaw immunohistochemical method was used to detect 21 cases of HSIL, 30 cases of early stage SCC and 30 cases of normal cervical tissue confirmed by colposcopy in gynecology clinic of the Second Hospital of Shanxi Medical University from November 2014 to April 2015 Control group). Human papillomavirus (HPV) and liquid-based thin-layer cytology (TCT) tests were performed on these cases. Results The positive rates of FRα in control group, HSIL group and SCC group were 26.7%, 85.7% and 76.7%, respectively. There was significant difference among the three groups (χ2 = 19.368, P <0.001). Among them, the positive rate of FRα in HSIL and SCC was higher than that in control group (P <0.05), but there was no significant difference between HSIL and SCC (P> 0.05). The detection rate of HSIL in FRα-positive patients was 34.0%, which was higher than that of HPV-positive patients (33.3%) in TCT positive patients. The sensitivity and specificity of FRα rapid immunohistochemistry in detecting HSIL Degrees were 76.2% and 93.3% respectively. The area under the receiver operating characteristic curve (ROC) was 0.848, higher than that of HPV and TCT. TCT tandem FRα is the best one in any two joint detection. Conclusion The fast frozen immunohistochemical detection of FRα protein expression can be used as an objective biological index to improve the detection rate of HSIL.