增殖细胞核抗原和上皮膜抗原在胸腺瘤组织的表达及其临床意义

Expression and clinical significance of proliferation cell nuclear antigen and epithelial membrane antigen protein in thymoma

目的检测增殖细胞核抗原（Ki-67）和上皮膜抗原（EMA）在胸腺瘤组织的表达，探讨其临床意义。方法采用免疫组织化学Envision二步法检测Ki-67和EMA在469例胸腺瘤不同Masaoka临床分期和世界卫生组织（WHO）病理分型中的表达，并对两者进行相关分析。结果Ki-67在Masaoka临床分期和WHO病理分型中，表达程度均逐渐增高，在Ⅰ～Ⅳb期Ki-67指数分别为（1．76±0．30）％、（2．23±0．28）％、（2．26±0．29）％、（7．69±0．63）％、（20．89±3．66）％、（24．89±3．54）％；在A型～B1胸腺癌Ki-67指数分别（1．77±0．31）％、（2．25±0．32）％、（2．55±0．36）％、（6．51±0．53）％、（9．33±0．66）％、（23．81±3．06）％，各组间差异均有统计学意义（P〈0．05）。Ki-67低表达主要在Ⅰ～Ⅱ期和A型-B1型，高表达主要在Ⅲ～Ⅳ期和B2型胸腺癌。EMA在Masaoka临床分期和WHO病理分型中表达程度逐渐降低，在Ⅰ—Ⅳb期积分分别为2．53±0．39、2．49±0．55、2．43±0．55、1．01±0．33、0．96±0．22、0．86±0.22。在A型-B1胸腺癌积分分别为2．55±0．22、2．57±0．19、2．52±0．16、1．12±0．10、1．06±0．12、0．87±0．15，各组间差异均有统计学意义（P〈0．05）。高表达主要在Ⅰ-Ⅱ期和A型～B1型，低表达主要在Ⅲ-Ⅳ期和B2型胸腺癌。Ki-67与EMA在胸腺瘤中表达呈负相关（P〈0．05）。结论Ki-67、EMA与胸腺瘤的发生、发展、侵袭有关，联合检测Ki-67和EMA可能有助于胸腺瘤良恶性的辅助诊断及临床分期和病理分型。

Objective To investigate the expression and clinical significance of proliferation cell nuclear antigen （ Ki - 67 ） and epithelial membrane antigen （EMA） protein in thymoma. Methods The expression of EMA and Ki -67 monoclonal antibody was detected by immunohistochemical Envision in different Masaoka stages and WHO type of 469 cases of thymoma, and the correlation between EMA and Ki - 67 was analyzed. Results In Masaoka stage and WHO type, the Ki - 67 expression level increased gradually. In stage Ⅰ - Ⅳb, the Ki - 67 index was （ 1.76 ±0. 30 ） %, （ 2.23 ±0. 28 ） %, （2. 26 ±0.29）%, （7.69 ±0.63）%, （20.89±3.66）% and （24.89 ±3.54）%, respectively. In type A-thymic carcinoma, the Ki -67 index was （1.77 ±0. 31）%, （2. 25 ±0. 32）%, （2. 55 ±0. 36）%, （6. 51 ± 0. 53）%, （9. 33 ±0. 66）%, and （23.81 s3.06）%, respectively （P〈0. 05）. The lower expression of Ki - 67 was mainly in stage Ⅰ - Ⅱ and type A - B1 thymoma, and the high expression of Ki - 67 was atmost in stage Ⅲ- Ⅳ and type B2 - thymic carcinoma. In Masaoka stage and WHO type, EMA expression level was reduced gradually. In stage Ⅰ - Ⅳb, score was 2. 53 ±0.39, 2.49 ±0.55,2.43 ±0. 55, 1.01 ± 0. 33, 0. 96 ± 0. 22 and 0. 86 ± 0. 22, respectively. In type A - thymic carcinoma, score was 2. 55 ±0.22, 2. 57±0.19, 2. 52 ±0.16, 1.12 ±0.10, 1.06 ±0.12, and 0.87 ±0.15, respectively （P〈 0. 05）. The high expression of EMA was mainly in stage Ⅰ - Ⅱ and type A - B1 thymoma. Nevertheless, the lower expression of EMA was almost in stage Ⅲ- Ⅳ and type B2 - thymic carcinoma. The Ki - 67 expression was negatively correlated with EMA expression in thymoma （ P 〈 0.05 ）. Conclusion Ki - 67 and EMA have an intimate association with occurrence, development and invasiveness of thymoma. The detection of Ki - 67 combine with EMA had a better contribution to benign and malignant diagnosis as well as Masaoka stage and WHO type.