胃肠道平滑肌肿瘤nm23表达与细胞增殖活性关系的研究

Expression of nm23 in gastrointestinal smooth muscle tumors and its relation to cell proliferative activity

目的探讨ｎｍ２３表达与胃肠道平滑肌肿瘤（ＧＩＳＭＴ）良恶性、恶性程度、转移、预后及细胞增殖活性的关系。方法采用免疫组化法检测８６例ＧＩＳＭＴ患者ｎｍ２３的表达情况，采用胶银染色法及免疫组化法检测核仁组成区嗜银蛋白（ＡｇＮＯＲｓ）、增殖细胞核抗原（ＰＣＮＡ）来反映细胞的增殖活性。结果ｎｍ２３的表达按平滑肌瘤、低度恶性平滑肌肉瘤、高度恶性平滑肌肉瘤的顺序依次明显下降（Ｐ＜０．０１）。ｎｍ２３表达与肿瘤的良恶性生长方式、大小、中心有无坏死亦有明显的关系（Ｐ＜０．０１或Ｐ＜０．０５）。ｎｍ２３阳性表达组的５年生存率明显高于阴性表达组（Ｐ＜０．０５）。ｎｍ２３阴性组的ＡｇＮＯＲｓ和ＰＣＮＡ表达明显高于ｎｍ２３阳性表达组（Ｐ＜０．０１）。结论ｎｍ２３是反映ＧＩＳＭＴ生物学特性的良好标志物，与ＡｇＮＯＲｓ、ＰＣＮＡ可互补作为判断ＧＩＳＭＴ良恶性、恶性程度、转移及预后的客观指标。

Objective To determine the relationship between nm23 expression and benign or malignant degree, metastasis, prognosis and cell proliferative activity of gastrointestinal smooth muscle tumors(GISMT). Method 86 cases of GISMT were studied, and nm23 was detected by the immunohistochemical staining SP method. The cell proliferative activity was evaluated by the silver colloid method for argyrophilic nucleolar organizer regions proteins(AgNORs) and by the immunohistochemical staining SP method for proliferating cell nuclear antigen (PCNA). Result The expression of nm23 declined significantly according to the following order:leiomyomas,low malignant leiomyosarcomas,high malignant leiomyosarcomas(P<001). The expression of nm23 was associated with the tumors with or without contiguous organ invasion or distant metastasis, the size of tumors, the tumors with or without center necrosis(P<001 or P<005). The fiveyear survival rate was significantly higher in patients with nm23 positive expression than that with nm23 negative expression(P<005). The expression of AgNORs and PCNA with nm23 negative cases was obviously higher than that with nm23 positive cases (P<001). Conclusion nm23 is a valuable indicator for the biological characteristics of GISMT. nm23 expression and cell proliferative activity can supply a deficiency each other in distingushing malignant from benign tumors, judging the malignant degree, and predicting the prognosis of the patients with GISMT.