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目的研究人端粒酶RNA基因(h TERC)在宫颈上皮内瘤变(CIN)及癌组织中的表达,评价其在宫颈癌筛查及CIN诊断中的意义。方法收集115例不同宫颈病变活检组织标本,其中正常组(含炎症者)25例,CINⅠ27例,CINⅡ26例,CINⅢ18例,宫颈癌(鳞癌)组19例,运用荧光原位杂交技术(FISH)检测组织中h TERC基因扩增情况,并以病理结果为标准评价其在宫颈癌筛查中的价值。结果 1h TERC基因在正常组和CINⅠ、Ⅱ、Ⅲ及宫颈癌组中的阳性扩增率分别为4%、22.2%、73.1%、83.3%和94.8%,各组间差异显著(P<0.01);h TERC基因扩增率与宫颈病变程度呈正相关(r=0.696,P<0.01);h TERC基因扩增的异常细胞数与宫颈病变程度也呈明显正相关(r=0.721,P<0.01)。当宫颈病变由≤CINⅠ转变为≥CINⅡ,h TERC基因扩增率及异常细胞数显著升高(P<0.01)。2h TERC基因检测识别≥CINⅡ的诊断敏感度为82.5%,特异度为86.5%,诊断准确率84.4%,阳性预测值88.1%,阴性预测值80.4%,诊断比值比为30.5,其筛查宫颈高级别病变的受试者工作特征(ROC)曲线下面积为0.862。结论 h TERC基因是一种有价值的遗传标记物,其异常扩增出现在宫颈病变早期,且随宫颈病变级别的增高而增高;h TERC基因单独检测在识别宫颈高级别病变的诊断价值较高,可作为辅助≥CINⅡ级病变的诊断;h TERC基因扩增对预测CIN进展为癌有一定的实用价值,可作为常规筛查方法的一种有效补充。
Objective To investigate the expression of human telomerase RNA (hTERC) gene in cervical intraepithelial neoplasia (CIN) and its cancerous tissues and to evaluate its significance in cervical cancer screening and CIN diagnosis. Methods Totally 115 cases of cervical lesions were collected from 25 patients with biopsy specimens, including 27 cases of CINⅠ, 26 cases of CINⅡ, 18 cases of CINⅢ, 19 cases of cervical cancer (squamous cell carcinoma) and 19 cases of cervical cancer (squamous cell carcinoma). Fluorescence in situ hybridization (FISH) Detection of tissue h TERC gene amplification, and pathological results as a standard evaluation of cervical cancer screening value. Results The positive rate of TERC gene expression was 4%, 22.2%, 73.1%, 83.3% and 94.8% in normal group, CINⅠ, Ⅱ, Ⅲ and cervical cancer group at 1h, ; h TERC gene amplification rate and the degree of cervical lesions was positively correlated (r = 0.696, P <0.01); h TERC gene amplification of abnormal cell number and cervical lesions also showed a significant positive correlation (r = 0.721, . When cervical lesions changed from ≤CINⅠ to ≥CINⅡ, the rate of TERC gene amplification and abnormal cell number increased significantly (P <0.01). The diagnostic sensitivity and specificity of TERC gene recognition and detection for ≧ CINⅡ were 82.5%, 86.5%, 84.4%, 88.1% and 80.4%, respectively. The diagnostic odds ratio was 30.5. The area under the receiver operating characteristic (ROC) curve for grade lesions was 0.862. Conclusion h TERC gene is a valuable genetic marker, the abnormal amplification appears in the early cervical lesions, and with the increase of cervical lesions increased; h TERC gene alone in the diagnosis of high-grade cervical lesions of high diagnostic value , Can be used as a diagnosis of ≥CIN Ⅱ grade lesions; h TERC gene amplification for the prediction of CIN progression of cancer has a certain practical value, can be used as an effective complement to conventional screening methods.