maspin和p53在妊娠滋养细胞疾病中的表达及临床意义

Expression of maspin and p53 in Gestational Trophoblastic Disease and Its Clinical Significance

目的：探讨maspin和p53在妊娠滋养细胞疾病中的表达及临床意义. 方法：采用免疫组化PV9000法检测22例正常妊娠者,82例葡萄胎者（经随访35例发生恶变）,11例妊娠滋养细胞肿瘤患者的maspin及p53的表达. 结果：葡萄胎未恶变组与正常早期妊娠组比较、葡萄胎恶变组与葡萄胎未恶变组比较,maspin的阳性表达率降低,而p53的阳性表达率升高,差异有统计学意义（均P〈0.05）. 在血人绒毛膜促性腺激素β亚单位（β-hCG）〉105 U/L、子宫体积〉孕周、卵巢黄素化囊肿〉6 cm组maspin表达分别低于血β-hCG≤105 U/L、子宫体积≤孕周、卵巢黄素化囊肿≤6 cm组（P〈0.05）,而在血β-hCG〉105 U/L及卵巢黄素化囊肿〉6 cm组中p53表达升高（P〈0.05）,maspin与p53的表达有关（P〈0.05）.35例葡萄胎恶变者中,maspin在国际妇产科联盟（FIGO）预后评分≥7分组的表达较〈7分组降低,差异有统计学意义（P〈0.05）;p53在解剖学分期Ⅲ期组中的表达较Ⅰ~Ⅱ期组升高,差异有统计学意义（P〈0.05）. 结论：maspin的表达下调及p53的高表达可能是葡萄胎恶性转化的早期事件, 两者的联合检测可能对预测葡萄胎恶变及预后判定有一定参考价值.

Objective：To explore the expressions of maspin and p53 in gestational trophoblastic disease, and their roles in the development of hydatidiform mole. Methods：The expressions of maspin and p53 were detected by immunohistochemistry （PV9000） in 22 cases of normal early pregnancies, 82 cases of hydatidiform moles （35 cases were followed up to occur malignant transformation） and 11 cases of gestational trophoblastic tumors. Results：Hydatidiform mole without malignant transformation group and normal early pregnancy group, hydatidiform mole with malignant group and hydatidiform mole without malignant transformation group, the positive expression rate of maspin was significantly lower, but the positive expression rate of p53 was significantly higher, the difference was statistically significant （P〈0.05）. In moles with malignant high risk factors such asβ-hCG〉105 U/L, uterus volume〉gestation weeks, ovary lutein cyst〉6 cm, the expression of maspin was lower than those groups such asβ-hCG≤105 U/L,uterus volume≤gestation weeks, ovary lutein cyst≤6 cm （P〈0.05）, while the expression of p53 was higher in moles with malignant high risk factors such as β-hCG〉105 U/L,ovary lutein cyst 〉6 cm compared with those without risk factors groups （P〈0.05）. Maspin expression was correlated with p53 （P〈0.05）. In 35 cases of malignant moles the expression of maspin in FIGO prognostic score≥7 was lower than that in FIGO prognostic score〈7 （P〈0.05）. The expression of p53 in anatomy stagingⅢgroup was higher than that in anatomy stagingⅠ-Ⅱgroup （P〈0.05）. Conclusions：Decreased expression of maspin and high expression of p53 may be early events in the malignant transformation of hydatidiform mole. It is suggested that the joint detection of both proteins provide certain reference value in predicting hydatidiform mole malignant transformation and prognostic evaluation of gestational trophoblastic disease.