中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2009年
12期
883-886
,共4页
江静%魏丽惠%吴瑞芳%张果%乌兰娜%李静然%李一冰%屠铮%周艳秋%赵昀%CHEN Zhong
江靜%魏麗惠%吳瑞芳%張果%烏蘭娜%李靜然%李一冰%屠錚%週豔鞦%趙昀%CHEN Zhong
강정%위려혜%오서방%장과%오란나%리정연%리일빙%도쟁%주염추%조윤%CHEN Zhong
宫颈肿瘤%宫颈上皮内瘤样病变%乳头状瘤病毒%人%端粒%末端转移酶%原位杂交%荧光
宮頸腫瘤%宮頸上皮內瘤樣病變%乳頭狀瘤病毒%人%耑粒%末耑轉移酶%原位雜交%熒光
궁경종류%궁경상피내류양병변%유두상류병독%인%단립%말단전이매%원위잡교%형광
Cervix neoplasms%Cervical intraepithelial neoplasia%Papillomavirus%human%Telomerase%In situ hybridization%fluorescence
目的 探讨TERC基因作为宫颈病变筛查指标的临床意义.方法 选取在北京大学人民医院和北京大学深圳医院妇科门诊进行官颈病变筛杳的715例患者为研究对象,对其宫颈脱落细胞行液基细胞学榆查,并行第2代杂交捕获试验(HC-II)检测高危型人乳头状瘤病毒(HPV),必要时行阴道镜活榆及病理检查.荧光原位杂交(FISH)技术检测细胞内TERC基因的异常扩增情况.以病理检查结果为"金标准",将TERC基因异常扩增结果与液基细胞学检查和高危型HPV检测结果进行比较.结果 在宫颈液基细胞学检查结果为正常、未明确诊断意义的不典型鳞状上皮细胞(ASCUS)、不除外高度病变的不典型鳞状上皮细胞(ASC-H)、低度鳞状上皮内病变(LSIL)、高度鳞状上皮内病变(HSIL)和不典型腺细胞(AGC)中,TERC基因异常扩增率分别为5.8%、22.2%、30.8%、27.8%、86.4%和1/1,正常、ASCUS、ASC-H和LSIL者均明显低于HSIL者(P<0.01).在病理检查结果为官颈上皮内瘤变(CIN)I、CIN Ⅱ～Ⅲ和浸润癌中,TERC基冈异常扩增率分别为9.3%、77.8%和96.7%,CIN I明显低于后两者(P<0.01).HPV检测结果为阳性患者的TERC基因扩增阳性率明显高于HPV阴性者(分别为33.5%和5.2%,P<0.01).TERC基因异常扩增诊断CIN Ⅱ及以上病变的敏感度为81.88%,明显高于细胞学检查的36.96%(P<0.01);其特异度(93.32%)明显高于HPV 检测的33.93%(P<0.01);阳性预测值(81.29%)与细胞学检查(86.44%)相似(P>0.05);而阴性预测值(93.56%)低于HPV检测(97.06%,P<0.05).结论 随着宫颈病变程度的加重,TERC基因异常扩增率增加,且其扩增与HPV感染有关.应用FISH技术检测TERC基因异常扩增作为分子遗传学指标,可以辅助细胞学榆查和HPV检测,协助筛出CIN Ⅱ及以上的高度病变和宫颈癌.
目的 探討TERC基因作為宮頸病變篩查指標的臨床意義.方法 選取在北京大學人民醫院和北京大學深圳醫院婦科門診進行官頸病變篩杳的715例患者為研究對象,對其宮頸脫落細胞行液基細胞學榆查,併行第2代雜交捕穫試驗(HC-II)檢測高危型人乳頭狀瘤病毒(HPV),必要時行陰道鏡活榆及病理檢查.熒光原位雜交(FISH)技術檢測細胞內TERC基因的異常擴增情況.以病理檢查結果為"金標準",將TERC基因異常擴增結果與液基細胞學檢查和高危型HPV檢測結果進行比較.結果 在宮頸液基細胞學檢查結果為正常、未明確診斷意義的不典型鱗狀上皮細胞(ASCUS)、不除外高度病變的不典型鱗狀上皮細胞(ASC-H)、低度鱗狀上皮內病變(LSIL)、高度鱗狀上皮內病變(HSIL)和不典型腺細胞(AGC)中,TERC基因異常擴增率分彆為5.8%、22.2%、30.8%、27.8%、86.4%和1/1,正常、ASCUS、ASC-H和LSIL者均明顯低于HSIL者(P<0.01).在病理檢查結果為官頸上皮內瘤變(CIN)I、CIN Ⅱ～Ⅲ和浸潤癌中,TERC基岡異常擴增率分彆為9.3%、77.8%和96.7%,CIN I明顯低于後兩者(P<0.01).HPV檢測結果為暘性患者的TERC基因擴增暘性率明顯高于HPV陰性者(分彆為33.5%和5.2%,P<0.01).TERC基因異常擴增診斷CIN Ⅱ及以上病變的敏感度為81.88%,明顯高于細胞學檢查的36.96%(P<0.01);其特異度(93.32%)明顯高于HPV 檢測的33.93%(P<0.01);暘性預測值(81.29%)與細胞學檢查(86.44%)相似(P>0.05);而陰性預測值(93.56%)低于HPV檢測(97.06%,P<0.05).結論 隨著宮頸病變程度的加重,TERC基因異常擴增率增加,且其擴增與HPV感染有關.應用FISH技術檢測TERC基因異常擴增作為分子遺傳學指標,可以輔助細胞學榆查和HPV檢測,協助篩齣CIN Ⅱ及以上的高度病變和宮頸癌.
목적 탐토TERC기인작위궁경병변사사지표적림상의의.방법 선취재북경대학인민의원화북경대학심수의원부과문진진행관경병변사묘적715례환자위연구대상,대기궁경탈락세포행액기세포학유사,병행제2대잡교포획시험(HC-II)검측고위형인유두상류병독(HPV),필요시행음도경활유급병리검사.형광원위잡교(FISH)기술검측세포내TERC기인적이상확증정황.이병리검사결과위"금표준",장TERC기인이상확증결과여액기세포학검사화고위형HPV검측결과진행비교.결과 재궁경액기세포학검사결과위정상、미명학진단의의적불전형린상상피세포(ASCUS)、불제외고도병변적불전형린상상피세포(ASC-H)、저도린상상피내병변(LSIL)、고도린상상피내병변(HSIL)화불전형선세포(AGC)중,TERC기인이상확증솔분별위5.8%、22.2%、30.8%、27.8%、86.4%화1/1,정상、ASCUS、ASC-H화LSIL자균명현저우HSIL자(P<0.01).재병리검사결과위관경상피내류변(CIN)I、CIN Ⅱ～Ⅲ화침윤암중,TERC기강이상확증솔분별위9.3%、77.8%화96.7%,CIN I명현저우후량자(P<0.01).HPV검측결과위양성환자적TERC기인확증양성솔명현고우HPV음성자(분별위33.5%화5.2%,P<0.01).TERC기인이상확증진단CIN Ⅱ급이상병변적민감도위81.88%,명현고우세포학검사적36.96%(P<0.01);기특이도(93.32%)명현고우HPV 검측적33.93%(P<0.01);양성예측치(81.29%)여세포학검사(86.44%)상사(P>0.05);이음성예측치(93.56%)저우HPV검측(97.06%,P<0.05).결론 수착궁경병변정도적가중,TERC기인이상확증솔증가,차기확증여HPV감염유관.응용FISH기술검측TERC기인이상확증작위분자유전학지표,가이보조세포학유사화HPV검측,협조사출CIN Ⅱ급이상적고도병변화궁경암.
Objective To investigate the significance of genomic amplification of the telomerase RNA component (TERC) gene to serve as a genetic biomarker in the screening of cervical lesions.Methods A total of 715 cases were recruited,with liquid-based cytology diagnosis as normal (n=347),atypical squamous cells of undetermined significance (ASCUS,n=180),atypical squamous cells cannot exclude a high-grade lesion (ASC-H,n=13),low-grade squamous intraepithelial lesions (LSIL,n=115),high-grade squamous intraepithelial lesions(HSIL,n=59)and atypical glandular cells(AGC,n=1).The remaining cervical cells in the cytological preserving fluid were analyzed using a two-color fluorescence in situ hybridization (FISH) probe targeted to chromosome 3q26 containing TERC gene.The TERC gene findings were compared to the cytological and histological detected results,as well as high-risk human papillomavirus (HPV) detected results.Results Genomic amplification of TERC gene was found in 5.8% of normal specimens,22.2% of ASCUS.30.8% of ASC-H,27.8% of LSIL,86.4% of HSIL and 1/1 of AGC.The positive rate was significantly lower in normal,ASCUS,ASC-H and ISIL.compared with HSIL(all P<0.01).Significantly more cells with genomic amplification of TERC gene were found in cervical intraepithelial lesion(CIN) Ⅱ-Ⅲ than CIN Ⅰ (77.8% vs.9.3%),as well as invasive cervical cancer (96.7% vs.9.3%).both P < 0.01.The rate of TERC gene amplification was higher in HPV positive patients (33.5%) than in HPV negative patients(5.2%,P<0.01).The sensitivity of TERC gene amplification was significantly higher than that of cytological screening (81.88% vs.36.96%,P<0.01) in the differentiation of CIN Ⅱ or higher and CIN Ⅰ or lower diseases,its specificity Was hisher than high-risk HPV test (93.32% vs.33.93%,P<0.01) and positive prediction value (81.29%) was similar with cytological method (86.44%,P>0.05);but its negative prediction value (93.56%) was lower than HPV test (97.06%,P<0.05).Conclusions The positive rates of TERC gene amplification increased as cervical diseases worsened.TERC gene amplification is related to HPV infection.The gain of chromosome 3q26 in cytological specimens is an effective molecular genetic biomarker in screening of CIN Ⅱ or higher and invasive cervical cancer.
