胆囊不同病变中S-100蛋白阳性树突状细胞浸润及其与肿瘤相关标记表达的关系

Relationship between S-100 Protein Positive Dendritic Cell Infiltration and Expression of Tumor-associated Markers in Different Gallbladder Lesions

70例不同胆囊病变标本包括胆囊腺癌30例］、胆结石20例、慢性胆囊炎20例，应用免疫组化观察P53蛋白、癌胚抗原（CEA）、增殖细胞核抗原（PCNA）表达状态及病变组织内S－100蛋白阳性树突状细胞（S-100+DC）浸润情况。p53蛋白、CEA及PCNA表达的阳性检出率，胆囊癌组分别为46．7％（14／30）、30％（9／30）及86．7％（26／30）；胆囊结石组分别为0、15％（3／20）及35％（7／20）；胆囊炎组分别为0、0及25％（5／20）。癌与非癌病变之间有明显差异（P＜0．05）。S-100+DC浸润阳性检出率，癌组织为40％（12／30）、胆囊结石组织为50％（10／20）、胆囊炎为85％（17／20）。S－100+DC的阳性检出率与组织内浸润细胞的密度，胆囊炎组与癌、胆囊结石组之间均存在明显统计学差异（P＜0．05）。研究结果提示：1）胆囊炎组织无肿瘤相关分子表达，但存在较高的免疫活性；2）胆结石标本内存在某些上皮细胞恶性转化，且其免疫活性有所降低。这种病变可能有较高肿瘤发生的危险；3）胆囊癌组织不仅有突变型P53基因、CEA及PCNA的过度表达，同时伴有免疫能力的损害，丧失了对肿瘤细胞的免疫监视作用，从而有利于癌的发展。

Expressions of tumor-associated markers and S-100+ dendritic cell infiltration in resected gallbladder specimens of 70 patients with various lesions including adenocarcinoma 30, cholecystolithiasis 20, and chronic cholecystitis 20 were studied immunohistochemically. The expressions of p53 protein, CEA and PCNA were found in 46. 7 % (14/30), 30% (9/30), 86. 7 % (26/30) in carcinomatous lesions; and were 0, 15 % (3/20), and 35% (7/20) in cholecystolithiasis; and 0%, 0 %, 25 % (5/20)in inflalmmatory lesions respectively. It was revealed that there was a significant difference between carcinomatous and non-neoplastic lesions (P< 0. 05). The frequency of positive finding of S-100+ DC in carcinoma, cholecystolithiasis and chronic cholecystitis were as much as 40 % (12/30 ), 50% (10/20 ), 85 % (17/20)respectively (P<0. 05 ). The present data suggest that: 1 )inflammatory lesion has no tumor-related molecular expression but a higher immunoconlpetency in eplthelial tissues; 2 )malignant change of epithelial cells may occur in some gall stone patients in whom immunoactivity declines; 3 ) in carcinomatous lesions there are overexpression of mutant p53 genes,CEA,PCNA and impaired imrnunocompetency which might predispose to neoplastic transformation.