PCNA与AgNOR检测在诊断子宫内膜病变中的应用

Application of Proliferating Cell Nuclear Antigen and Argentophilic Protein at Nucleolus Organizer Region to Diagnosis of Endometrial Diseases

目的探讨增殖细胞核抗原(PCNA)与核仁组成区嗜银蛋白(AgNOR)在子宫内膜样腺癌早期诊断与预后中的作用。方法采用免疫组化SP法及银染法,检测132份不同子宫内膜组织中PCNA的增殖指数与AgNOR颗粒数,并分析其与各临床病理指标的相关性以及二者之间的联系。结果PCNA增殖指数与AgNOR颗粒数在正常子宫内膜(16%,2.51±1.97)、子宫内膜增殖症(40%,2.92±2.02)、子宫内膜非典型增生(63.16%,3.04±2.05)、子宫内膜样腺癌组织(74.60%,7.43±2.18)中依次呈升高趋势;且在子宫内膜样腺癌组织中,PCNA增殖指数显著高于子宫内膜增殖症及正常子宫内膜组织,AgNOR颗粒数显著高于良性病变组及正常子宫内膜,形态由单一型向弥散型转变。在子宫内膜样腺癌组织中,随着临床分期的进展、细胞分化程度的降低和淋巴结的转移,PCNA增殖指数与AgNOR颗粒数逐渐增高,差异有显著意义。在不同子宫内膜组织中,PCNA增殖指数与AgNOR颗粒数呈正相关。结论PCNA增殖指数和AgNOR颗粒数与子宫内膜样腺癌的发生、发展密切相关。联合检测PCNA与AgNOR的定量值对早期诊断子宫内膜样腺癌、判断疾病预后有一定的临床价值。

Objective To explore the roles of proliferating cell nuclear antigen （PCNA） and argentophilic protein at nucleelus organizer region（AgNOR） in diagnosis and progenosis of endometrial adenocarcinoma. Methods Determine the proliferation index of PCNA and the number of AgNOR particles in 132 endometrial tissue specimens by immunohistochemical SP method and silver staining respectively, and analyze the relationship between them as well as their relationship to various pathological indexes in clinic. Results The proliferation index of PCNA and the number of AgNOR particles were 16% and 2. 51 ± 1.97 in normal endometrial tissue specimens,40% and 2. 92 ±2. 02 in the specimens from patients with hyperplasia of endometrium,63. 16% and 3.04 ±2. 05 in those with atypical endometrial proliferation, and 74. 60% and 7.43 ± 2. 18 in those with endometrial adenocareinoma,respectively, which showed an increasing tendency as the progress of endometrial divines. The proliferation index of PCNA in endometrial odenocarcinoma tissue was significantly higher than those in normal endometrial tissue and in the tissues from patients with hyperplasia of endometrium. The morphology of AgNOR particles in endometrial adenocareinoma tissue changed from unique form to diffuse form,and its number was significantly higher than those in normal endometrial tissue as well as the tissues from patients with hyperplasia of denometrium and with atypical endometrial proliferation. In endometrial adenocarcinoma tissue, the PCNA proliferation index and the number of AgNOR particles increased gradually with the progress of clinical phase,degrade of cell differentiation and metastasis in lymph nodes,and showed significant difference. In all the endometrial tissues, the proliferation index of PCNA was positively related to the number of AgNOR partides. Conclusion Both the proliferation index of PCNA and the number of AgNOR particles were closely related to the incidence and progress of endometrial adenocarcinoma. The combined determination of PCNA and AgNOR was of a certain significance in the early diagnosis and prognosis of endometrial odenocaroinoma.