P57、P63和Ki-67在水肿性绒毛中的鉴别诊断意义

Expression and significance of P57, P63 and Ki-67 in the placental villi with hydropic changes

目的探讨P57、P63和Ki-67在水肿性绒毛中的表达及其意义。方法利用免疫组织化学技术检测23例部分性水泡状胎块（partialhydatidiformmoles，PHM）、20例完全性水泡状胎块（completehydatidiformmoles，CHM）及13例早期水肿性流产的活检组织进行检查。结果P57在完全性水泡状胎块中不表达（19／20）或仅微弱表达（1／20）；相反，在所有的部分性水泡状胎块中，细胞滋养层细胞及绒毛间质细胞均表达P57（23／23），且13例呈中等至强阳性表达；在大部分水肿性流产中，P57均表达（11／13）。P57在CHM与PHM、CHM与HA之间的表达差异均有统计学意义（P〈0．01）。Ki-67在水泡状胎块中的表达明显高于水肿性流产（P〈0．05）。无论是阳性细胞数量还是阳性程度，P63在三种病变中的表达均无明显差异。结论P57和Ki-67在水肿性绒毛中的表达与其临床分型显著相关，运用免疫组织化学染色的方法，联合检测P57和Kb67对鉴别不同类型的水肿性绒毛具有临床意义。P63在水肿性绒毛中的作用尚待进一步研究。

Objective To investigate the expression and significance of P57, P63 and Ki-67 in the placental villi with hydropic changes. Methods 23 partial hydatidiform moles （PHM） patients, 20 complete hydatidiform moles （CHM） patients and 13 first trimester hydropic abortions patients were evaluated by means of immunohistochemical technique in this study. Results The results of immunohistochemical staining showed that P57 expression in cyto- trophoblasts was either absent （19 cases） or very low （1 case） in CHM. In contrast, in all PHM, nuclear P57 was expressed in cytotrophoblasts and villous stromal cells （23/23）. Meanwhile, P57 was moderately and strongly ex- pressed in 13 cases. In the majority of hydropic abortions （11/13）, P57 expression was observed. There was a sig- nificant difference between CHM and PHM, CHM and HA（P〈 0.01 ）. The Ki-67 immunoreactivity was signifi- cantly higher in the hydatidiform moles group than in the abortion group with hydropic changes （P〈0.05 }. No matter the quantity of immunostaining or the intensity of immunostaining, there was no significant difference in ex- pression of P63 among hydropic abortion, PHM and CHM. Conclusion Our findings suggest that expression of P57 and Ki-67 can be used to differentiate between abortion with hydropic changes and hydatidiform moles when two markers are used together by means of immunohistochemical technique. The role of P63 in the placental villi with hydropic changes, however, further investigation is required.