CAJ | 학술논문

目的:探讨吲哚胺2,3-二氧酶(indoleamine 2,3-dioxygenase,IDO)在宫颈鳞癌发生发展中的作用.方法:选择2008年1月至12月在昆明医学院第三附属医院病理确诊为宫颈上皮内瘤样病变(cervical intraepithelial neoplasia,CIN)Ⅰ～Ⅲ和宫颈鳞癌的病灶组织石蜡标本116例及转移淋巴结石蜡标本18例.以正常宫颈组织石蜡标本20例及无转移淋巴结组织石蜡标本20例作为对照,采用免疫组化方法分析组织中IDO的表达.结果:正常宫颈(20例)及CINⅠ组织(10例)中IDO表达均为阴性,20%(2/10)的CIN Ⅱ期组织表达为弱阳性,其余为阴性(80%,8/10),CINⅢ中有61.5%(8/13)的组织呈弱阳性表达,7.7%(1/13)的组织为阳性表达,30.8%(4/13)的组织为阴性表达,宫颈癌Ⅰ～Ⅳ的阳性表达率为100%(83/83),Ⅰ A期和Ⅰ B期阳性表达率显著高于CINⅡ和CIN Ⅲ(P<0.01),ⅡA～ⅣB阳性表达率显著高于Ⅰ A期和Ⅰ B期(p<0.01).IDO表达与宫颈癌进展有关(OR=0.807,P<0.01).淋巴结转移阳性患者的宫颈癌组织阳性表达率显著高于淋巴结转移阴性患者(P<0.01),淋巴结转移组织中阳性表达率显著高于淋巴结转移阴性组织(P<0.01),IDO阳性表达率与肿瘤分化程度无关(OR=-0.139,P>0.05).结论:从CIN Ⅱ开始,肿瘤组织已逐步建立有利于肿瘤发展的免疫逃逸机制,转移淋巴结IDO表达阳性可能与机体免疫系统选择性免疫耐受有关.IDO的表达与疾病进展有关而与肿瘤组织分化程度无关,IDO可能成为宫颈鳞状细胞癌预后的预测因子及治疗靶点.
목적:탐토신타알2,3-이양매(indoleamine 2,3-dioxygenase,IDO)재궁경린암발생발전중적작용.방법:선택2008년1월지12월재곤명의학원제삼부속의원병리학진위궁경상피내류양병변(cervical intraepithelial neoplasia,CIN)Ⅰ～Ⅲ화궁경린암적병조조직석사표본116례급전이림파결석사표본18례.이정상궁경조직석사표본20례급무전이림파결조직석사표본20례작위대조,채용면역조화방법분석조직중IDO적표체.결과:정상궁경(20례)급CINⅠ조직(10례)중IDO표체균위음성,20%(2/10)적CIN Ⅱ기조직표체위약양성,기여위음성(80%,8/10),CINⅢ중유61.5%(8/13)적조직정약양성표체,7.7%(1/13)적조직위양성표체,30.8%(4/13)적조직위음성표체,궁경암Ⅰ～Ⅳ적양성표체솔위100%(83/83),Ⅰ A기화Ⅰ B기양성표체솔현저고우CINⅡ화CIN Ⅲ(P<0.01),ⅡA～ⅣB양성표체솔현저고우Ⅰ A기화Ⅰ B기(p<0.01).IDO표체여궁경암진전유관(OR=0.807,P<0.01).림파결전이양성환자적궁경암조직양성표체솔현저고우림파결전이음성환자(P<0.01),림파결전이조직중양성표체솔현저고우림파결전이음성조직(P<0.01),IDO양성표체솔여종류분화정도무관(OR=-0.139,P>0.05).결론:종CIN Ⅱ개시,종류조직이축보건립유리우종류발전적면역도일궤제,전이림파결IDO표체양성가능여궤체면역계통선택성면역내수유관.IDO적표체여질병진전유관이여종류조직분화정도무관,IDO가능성위궁경린상세포암예후적예측인자급치료파점.
Objective: To investigate the role of indoleamine 2, 3-dioxygenase in the development of uterine cervical squamous carcinoma. Methods: From January 2008 to December 2008, 116 uterine cervical carcinoma specimens and 18 metastatic lymph node specimens from patients with CIN Ⅰ-Ⅲ and uterine cervical squamous carcinoma were evaluated for iDO expression by immunohistochemistry. Twenty normal cervical specimens and 20 normal lymph node specimens were used as the controls. Results: The expression of IDO was not found in normal cervix and CIN Ⅰ. In CIN Ⅱ, IDO expres-sion was weakly positive in 2 cases (2/10, 20%) and negative in 8 cases (8/10, 80%). In CIN Ⅲ, IDO expression was weak-ly positive in 8 cases (8/13, 61.5%), positive in 1 case (1/13, 7.7%) and negative in 4 cases (4/13, 30.8%). The positive ex-pression rate of IDO in cervical cancer stage Ⅰ -Ⅳ was 100% (83/83). In cervical cancer stage Ⅰ A and Ⅰ B, the positive ex-pression rate of IDO was significantly higher than that in CIN Ⅱ and CIN Ⅲ (P<0.01). The positive expression rate of IDO in cervical cancer stage Ⅱ A-Ⅳ B was significantly higher than that in Ⅰ A and Ⅰ B. IDO expression was associated with cervi-cal cancer progression (OR=0.807, P<0.01). IDO expression in primary lesions with lymph node metastasis was significant-ly higher than that in those without lymph node metastasis. IDO expression rate was 100% in metastatic lymph nodes. The IDO expression was not associated with cervical squamous carcinoma differentiation degree (OR=-0.139,P>0.05). Conclu-sion: In CIN Ⅱ, escape mechanisms that stimulate cervical squamous carcinoma progression is gradually developed. IDO expression in metastatic lymph nodes is possibly associated with immune tolerance. IDO expression is not associated with differentiation degree of cervical squamous carcinoma. IDO may be a prognostic factor for uterine cervical squamous carci-noma and a therapeutic target for treatment.