库欣综合征中FHIT、Ki-67、PCNA的表达及相关因素的研究

Expression of FHIT, Ki-67 and PCNA in Cushing syndrome and related factors

目的探讨库欣综合征肾上腺皮质病变中肿瘤抑制基因脆性组氨酸三联体(FHIT)、肿瘤增殖抗原Ki-67、增殖细胞核抗原(PCNA)的表达,探索鉴别库欣综合征肾上腺皮质病变的相关因素。方法应用免疫组织化学方法检测49例库欣综合征肾上腺皮质病变(腺癌14例、腺瘤26例、增生9例)中FHIT、Ki-67、PCNA的表达,对临床病理及生化指标采用有序结果的累积比数Logistic回归分析探索鉴别库欣综合征皮质病变的相关因素。结果 FHIT在肾上腺皮质增生中表达最高,腺瘤次之,腺癌最低(分别为100%、96.15%和42.96%),Ki-67与PCNA在肾上腺皮质腺癌的表达最高,腺瘤次之,增生最低(分别为85.71%、7.69%、0.00%和100%、96.15%、77.78%)。应用Logistic回归分析发现FHIT、PCNA两个因素与鉴别腺癌、腺瘤、增生的关系更为密切。结论 FHIT、Ki-67和PCNA的表达与库欣综合征肾上腺皮质病变密切相关。Logistic回归分析提示FHIT、PCNA与鉴别诊断的关系更为密切。

Objective To study the expression of FHIT, Ki-67 and PCNA in hypercortisolism of various adrenocortical diseases and explore the correlative factors of the differential diagnosis of hypercortisolism of adrenocortical adenocarcinoma, adenoma and hyperplasia. Methods The expressions of FHIT, Ki-67 and PCNA were detected by immunohistochemical staining in 49 cases of adrenocortical diseases, which included 14 cases of adrenocortical carcinoma, 26 cases of adrenocortical adenoma and 9 cases of adrenocortical hyperplasia. The factors correlated to differential diagnosis of hypercortisolism of various adrenocortical diseases were analyzed statistically by ordinal logistic regression. Results The expression rate of FHIT in adrenocortical hyperplasia, adrenocortical adenoma and adrenocortical adenocarcinoma was 100.00%, 96.15% and 42.96%, respectively. The expression rate of Ki-67 in adreno cortical adenocarcinoma and adrenocortical adenoma was 85.71% and 7.96%, respectively, while there was no expression at all in adrenocortical hyperplasia （0.00%）. The expression rate of PCNA in adrenocortical adenocarcinoma, adrenocortical adenoma and adrenocortical hyperplasia was 100.00%, 96.15% and 77.78%, respectively. Logistic regression single-factor analysis revealed that 8 factors including FHIT, Ki-67, PCNA, abdominal mass, tumor size, osteopenia or fracture, serum cortisol level （4 pm） and blood ACTH level （8 am） were possibly linked to the differential diagnosis of hypercortisolism of the adrenocortical diseases, and multiple-factor analysis showed that FHIT and PCNA were the factors closely correlated to differential diagnosis of adrenocortical carcinoma, adenoma and hyperplasia. Conclusions The expressions of FHIT, Ki-67 and PCNA are strongly related with hypercortisolism of various adrenocortical diseases. They might be applied as the markers for distinguishing adrenocortical carcinoma, adrenocortical adenoma and adrenocortical hyperplasia. The results of logistic regression analysis suggest that FHIT, Ki-67, PCNA, abdominal mass, tumor size, osteopenia or fracture, serum cortisol （4 pm） and blood ACTH level （8 am） may be the correlated factors of differential diagnosis of adrenocortical carcinoma, adenoma and hyperplasia; moreover, FHIT and PCNA are the factors closely correlated to differential diagnosis of hypercortisolism of adrenocortical diseases.