CAJ | 학술논문

目的：探讨宫颈组织人染色体端粒酶（ human telomerase RNA component ，hTERC）基因检测在宫颈癌筛查中的意义。方法收集2008年10月至2011年2月暨南大学附属第一医院166例宫颈石蜡标本，根据病理结果分为对照组18例（正常宫颈、慢性宫颈炎或鳞状上皮化生）；宫颈上皮内瘤变（ cervical imtrae pithelial neoplasia ，CIN）Ⅰ组30例；CINⅠ－Ⅱ组28例；CINⅡ组35例；CINⅢ组35例；宫颈癌组20例，其中初治15例（鳞癌11例，腺鳞癌3例，腺癌1例），治疗后复发5例。应用荧光原位杂交（ FISH）技术检测上述标本的hTERC基因表达情况，并与宫颈癌其他筛查方法进行比较。结果（1）对照组、CINⅠ、CINⅠ－Ⅱ、CINⅡ、CINⅢ及宫颈癌组中hTERC基因扩增率分别为5.6％、10.0％、32.1％、65.7％、88.6％及95.0％。对照组和CINⅠ组hTERC基因扩增率均显著低于CINⅠ－Ⅱ、Ⅱ、Ⅲ级和宫颈癌组（均P＜0.05）；宫颈组织中hTERC基因的扩增率随着宫颈病变程度递增而逐渐增加（χ2＝12.270，P＜0.05）。（2）宫颈组织hTERC基因检测对预测宫颈高级别病变的灵敏度、特异度、准确度、阳性预测值、阴性预测值、阳性似然比、阴性似然比及约登指数分别为81.1％、79.3％、80.4％、85.9％、73.0％、3.92、0.24及0.60。结论宫颈组织中hTERC基因检测对宫颈高度病变具有较高的检出率。
목적：탐토궁경조직인염색체단립매（ human telomerase RNA component ，hTERC）기인검측재궁경암사사중적의의。방법수집2008년10월지2011년2월기남대학부속제일의원166례궁경석사표본，근거병리결과분위대조조18례（정상궁경、만성궁경염혹린상상피화생）；궁경상피내류변（ cervical imtrae pithelial neoplasia ，CIN）Ⅰ조30례；CINⅠ－Ⅱ조28례；CINⅡ조35례；CINⅢ조35례；궁경암조20례，기중초치15례（린암11례，선린암3례，선암1례），치료후복발5례。응용형광원위잡교（ FISH）기술검측상술표본적hTERC기인표체정황，병여궁경암기타사사방법진행비교。결과（1）대조조、CINⅠ、CINⅠ－Ⅱ、CINⅡ、CINⅢ급궁경암조중hTERC기인확증솔분별위5.6％、10.0％、32.1％、65.7％、88.6％급95.0％。대조조화CINⅠ조hTERC기인확증솔균현저저우CINⅠ－Ⅱ、Ⅱ、Ⅲ급화궁경암조（균P＜0.05）；궁경조직중hTERC기인적확증솔수착궁경병변정도체증이축점증가（χ2＝12.270，P＜0.05）。（2）궁경조직hTERC기인검측대예측궁경고급별병변적령민도、특이도、준학도、양성예측치、음성예측치、양성사연비、음성사연비급약등지수분별위81.1％、79.3％、80.4％、85.9％、73.0％、3.92、0.24급0.60。결론궁경조직중hTERC기인검측대궁경고도병변구유교고적검출솔。
Objective To investigate the genomic amplification of human telomerase gene ( hTERC ) in paraffin -embedded tissues of cervical intraepithelial neoplasia (CIN) and cervical cancer (CC) by fluorescence in situ hybridization (FISH) in order to evaluate its clinical significance in cervical cancer screening .Methods The genomic amplification of hTERC gene in 166 cases of cervical paraffin-embedded tissues were delected by FISH collected The First Affiliated Hospital of Jinan University from October 2008 to February 2011.According to the histology biopsy , 166 cases divided into the control group (18 cases of normal , chronic cervicitis or metaplasia of squamous epithelium )and the study groups (166 cases), including CINⅠ(30 cases), CINⅠ-Ⅱ(28 cases), CINⅡ(35 cases), CINⅢ(35 cases) and cervical cancer (20 cases), of which 15 cases of initial treatment (11 cases of squamous cell carcinoma, 3 cases adenosquamous carcinoma , and 1 case adenocarcinoma ) and 5 cases of relapse after treatment .To detect the genomic amplification of hTERC gene in the paraffin tissues of each group by FISH , and compared with the results of cervical cytology , HPV-DNA detection, colposcopy.Results (1)The genomic amplification rate of hTERC gene in the control group , CIN Ⅰ, CINⅠ-Ⅱ, CIN Ⅱ, CINⅢand cervical cancer group were 5.6%, 10.0%, 32.1%, 65.7%, 88.6% and 95.0% respectively .The difference of hTERC genomic amplification between control group , CINⅠand CINⅠ -Ⅱ, CINⅡ, CINⅢ, cervical cancer was statistically significant (P<0.05).The genomic amplification rate of hTERC increased with the degree of cervical lesion gradually increased (χ2 =12.270, P<0.05).(2) The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio , negative likelihood ratio and Youden index of the genomic amplification of hTERC in the paraffin specimens for predicting high -grade cervical lesions were 81.1%, 79.3%, 80.4%, 85.9%, 73.0%, 3.92, 0.24 and 0.60 respectively. Conclusion The amplification of hTERC in the paraffin -embedded tissues have high positive rate for predicting high -grade cervical lesions.