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目的：研究从慢性胆囊炎，胆囊腺瘤至早期胆囊癌等多阶段发展过程中多种癌基因变化，进一步探讨胆囊癌的发病机理，寻找胆囊癌早期诊断的肿瘤标志物。方法：采用免疫组织化学Ｓ－Ｐ法检测慢性胆囊炎、胆囊腺瘤及早期胆囊癌的ｎｍ２３、ｐ５３、ｒａｓ、ｃ－ｍｙｃ、ｃ－ｅｒｂＢ－２等癌相关基因蛋白的表达。结果：①ｎｍ２３、ｐ５３、ｃ－ｍｙｃ、ｒａｓ及ｃ－ｅｒｂＢ－２基因在胆囊腺瘤及早期胆囊癌中有表达；②着色强度随病变发展逐渐增强；③２例胆囊腺瘤伴不典型增生呈强阳性表达；④ｐ５３基因仅见于早期胆囊癌；⑤联合癌基因ｐ５３、ｒａｓ，ｐ５３、ｃ－ｍｙｃ，ｐ５３、ｃ－ｅｒｂＢ－２及ｐ５３、ｒａｓ、ｃ－ｍｙｃ对诊断早期胆囊癌有价值。结论：ｐ５３，ｒａｓ，ｃ－ｍｙｃ及ｃ－ｅｒｂＢ－２可能与胆囊癌的发生有关，四者在胆囊癌的发生中可能起协同作用。
Objective: To study the changes of multiple oncogenes in the multistage development of chronic cholecystitis, gallbladder adenoma and early gallbladder carcinoma, and to further explore the pathogenesis of gallbladder carcinoma and find tumor markers for early diagnosis of gallbladder cancer. METHODS: Immunohistochemical S-P method was used to detect the expression of cancer-associated genes such as nm23, p53, ras, c-myc and c-erbB-2 in chronic cholecystitis, gallbladder adenoma and early gallbladder carcinoma. RESULTS: 1 nm23, p53, c-myc, ras and c-erbB-2 genes were expressed in gallbladder adenoma and early gallbladder carcinoma; 2 staining intensity gradually increased with the development of lesions; 32 gallbladder adenomas with dysplasia were strong Positive expression; 4p53 gene is only found in early gallbladder cancer; 5 combined with oncogenes p53, ras, p53, c-myc, p53, c-erbB-2 and p53, ras, c-myc for the diagnosis of early gallbladder cancer is valuable. CONCLUSIONS: p53, ras, c-myc, and c-erbB-2 may be involved in the development of gallbladder carcinoma. These may play a synergistic role in the development of gallbladder carcinoma.