胰岛素样生长因子-Ⅰ及Ⅰ型受体在子宫内膜增生及内膜腺癌中的表达

Expression of insulin-like growth factor-Ⅰ, -Ⅰ receptor in endometrial hyperplasia and adenocarcinoma

目的：探讨胰岛素样生长因-Ⅰ（IGF—Ⅰ）、胰岛素样生长因子-Ⅰ受体（IGF—IR）在子宫内膜增生性病变及内膜腺癌中的表达，为临床交界性内膜疾病的鉴别寻找新的分子标记物。方法：采用免疫组织化学SP法检测20例正常子宫内膜（正常组）、48例子宫内膜增生（增生组）及30例内膜腺癌（腺癌组）中IGF—Ⅰ／IR的表达。结果：①不典型增生（ATH）腺上皮细胞IGF—Ⅰ的组织学评分为（5．3±1．1）分，显著低于复杂性增生的（9．6±1．7）分，两者比较，差异有显著性（P〈0．01）；IGF—IR在ATH的组织学评分[（8．2±1．3）分]较单纯性增生[（4．2±1．6）分]明显增高（P〈0．01）。②IGF—Ⅰ／IR与腺癌的临床分期和组织学分级无相关性（r=0．308—0．524，P〉0．05）。③腺癌组IGF—Ⅰ的组织学评分为（7．1±2．0）分，与正常组的（4．4±0．9）分比较，无显著性差异（P〉0．05），而在良性增生内膜的组织学评分[（8．6±1．8）分]却明显高于正常组和ATH（P〈0．01）；腺癌组IGF—IR的组织学评分为（9．3±1．7）分，与ATH比较，无显著性差异（P〉0．05），但二者较正常组[（4．0±0．6）分]和良性增生[（4．8±1．1）分]明显增高（P〈0．01）。结论：IGF—IR可有望作为临床鉴别内膜细胞良恶性增生及癌变的重要分子标记物。

Objective ： To evaluate the expression of IGF - Ⅰ - Ⅰ R in endometrial hyperplasia and endometrial adenocarcinoma, and thus to explore new molecular indicators for differential diagnosis for endometrial borderline diseases. Methods： Immunohistochemical staining for IGF - Ⅰ/- Ⅰ R were performed by SP in 20 cases of normal endometrium, 48 cases of endometrial hyperplasia and 30 cases of endometrial carcinomas. Results： （1）IGF - Ⅰ H - score of atypical hyperplasia （ATH） was significantly low relative to complex hyperplasia （5.3 ± 1.1 versus 9. 6 ± 1.7, P 〈0. 01 ）, nevertheless, IGF - Ⅰ R H - score of ATH was significantly high compared with that of simple hyperplasia （8. 2 ± 1.3 versus 4. 2 ± 1.6, P 〈0. 01 ） . （2）No apparent linear relationship was detected between IGF - Ⅰ / - Ⅰ R and clinical stage ＆ histological grade of endometrial adenocarcinomas （ r = 0. 308 -0. 524, P 〉 0. 05 ） . （3）Any significant difference in the IGF - Ⅰ H - score was found between endometrial adenocarcinomas and nomal endometrium （7.1 ± 2.0 versus 4. 4 ± 0. 9, P 〉 0. 05 ） . Instead, its H - score of benign hyperplasia （8. 6 ± 1.8） was much higher than that of normal endometrium and ATH （ P 〈 0. 01 ） . In marked contrast to normal endometrium and benign hyperplasia （4.0 ±0. 6 and 4. 8 ± 1.1 ）, IGF - Ⅰ R H - score of endometrial adenocarcinomas （9. 3 ± 1.7 ） increased significantly （P 〈 0. 01 ）, but showing no difference compared with ATH （P 〉 0. 05 ） . Conclusion： IGF - Ⅰ R may be used to differentiate the benign, malignant hyperplasia and tumorigenesis as an important molecular indicator.