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目的探讨maspin和c-erbB-2在妊娠滋养细胞疾病中的表达及临床意义。方法收集225例葡萄胎患者,随访3~27个月,27例发展为侵蚀性葡萄胎,12例发展为绒毛膜癌。采用免疫组化PV9000二步法检测24例正常早期妊娠(对照组)、49例葡萄胎(葡萄胎组)、39例妊娠滋养细胞肿瘤(侵葡+绒癌组)maspin和c-erbB-2的表达。结果葡萄胎组maspin阳性表达率(65.3%,32/49)与对照组(91.7%,22/24)及侵葡+绒癌组(35.9%,14/39)比较,差异有统计学意义(P<0.05)。hCG>105 U/L、子宫体积>孕周及卵巢黄素囊肿直径>6cm组maspin阳性率分别为34.6%(18/52)、37.0%(20/54)和36.6%(15/41),均低于无上述高危因素组(P<0.05)。葡萄胎组c-erbB-2阳性表达率(53.1%,26/49)与侵葡+绒癌组(74.4%,29/39)比较,差异有统计学意义(P<0.05)。子宫体积>孕周组c-erbB-2阳性表达率(74.1%,40/54)与子宫体积≤孕周组(44.1%,15/34)比较,差异有统计学意义(P<0.05)。葡萄胎组maspin与c-erbB-2的表达呈负相关(r=-0.270,P<0.05)。侵葡+绒癌组FIGO预后评分≥7分组maspin表达较<7分组明显下降(P<0.05)。结论maspin和c-erbB-2可作为预测葡萄胎恶变的参考指标,maspin的检测可能对妊娠滋养细胞疾病预后评估有一定的参考意义。
Objective To investigate the expression and clinical significance of maspin and c-erbB-2 in gestational trophoblastic diseases. Methods Totally 225 hydatidiform mole patients were recruited. The patients were followed up for 3 to 27 months. Twenty-seven patients developed invasive mole and 12 patients developed choriocarcinoma. Immunohistochemical PV9000 two-step method was used to detect the expression of maspin and c-erbB-2 in 24 cases of normal early pregnancy (control group), 49 cases of hydatidiform mole (hydatidiform mole), 39 cases of gestational trophoblastic tumor expression. Results The positive rate of maspin in hydatidiform mole group was significantly higher than that in control group (91.7%, 22/24) and invasive squamous cell carcinoma (35.9%, 14/39) (65.3%, 32/49) P <0.05). The positive rates of maspin were 34.6% (18/52), 37.0% (20/54) and 36.6% (15/41) in the group of uterus volume> gestational weeks and corpus luteum cyst> 6 cm in the group of hCG> 105 U / Were lower than those without risk factors (P <0.05). The positive rates of c-erbB-2 in hydatidiform mole group (53.1%, 26/49) were significantly higher than those in invasive fibroids + choriocarcinoma group (74.4%, 29/39) (P <0.05). The positive rates of c-erbB-2 expression in gestational age group (74.1%, 40/54) and uterine volume≤ gestational age group (44.1%, 15/34) were significantly different (P <0.05). The expression of maspin and c-erbB-2 in hydatidiform mole was negatively correlated (r = -0.270, P <0.05). The levels of maspin in FIGO prognosis score≥7 in invasion of TAP + choriocarcinoma group were significantly lower than those in <7 group (P <0.05). Conclusion maspin and c-erbB-2 can be used as a reference index to predict the malignancy of hydatidiform mole. Detection of maspin may be useful for the prognosis evaluation of gestational trophoblastic disease.