叶酸受体α在高度鳞状上皮内病变及早期宫颈鳞癌组织表达及其意义研究

Expression and clinical significance of the folate receptor alpha in high-grade squamous intraepithelial lesion and early invasive cervical cancer

目的探讨叶酸受体(FR)α在高度鳞状上皮内病变(HSIL)及早期宫颈鳞癌(SCC)组织中的表达及在提高HSIL检出率中的意义。方法采用快速冰冻免疫组化法检测2014年11月至2015年4月在山西医科大学第二医院妇科门诊经阴道镜宫颈组织病理证实的21例HSIL、30例早期SCC及正常宫颈组织30例(对照组)中FRα的表达。并对这些病例进行人乳头瘤病毒(HPV)和液基薄层细胞学(TCT)检查。结果在对照组、HSIL组和SCC组中,FRα阳性表达率依次为26.7%、85.7%、76.7%,3组间差异有统计学意义(χ2=19.368,P<0.001)。其中,HSIL、SCC组FRα阳性表达率高于对照组(P<0.05);但HSIL和SCC组间差异无统计学意义(P>0.05)。FRα阳性者中HSIL的检出率(34.0%),与TCT阳性者中HSIL的检出率(33.3%)相当,高于HPV(27.4%);FRα快速冰冻免疫组化检测HSIL的灵敏度和特异度分别为76.2%和93.3%,受试者工作特征曲线(ROC)下面积为0.848,高于HPV、TCT。两两联合检测中以TCT串联FRα效果最佳。结论快速冰冻免疫组化检测FRα蛋白表达可作为客观的生物指标提高HSIL的检出率。

Objective To detect the expression levels of folate receptor alpha in high-grade squamous intraepithelial lesion（HSIL）and early invasive cervical cancer tissues.Methods We randomly collected cervical tissues of patients,who were diagnosed with normal cervix（control,30 cases）,HSIL（21 cases）and early invasive cervical cancer（30 cases）from November 2014 to April 2015 at the Second Hospital of Shanxi Medical University.The expression of folate receptor alpha was detected by rapid freezing immunohistochemical technique.Results In control,HSIL and cervical cancer group,FRα positive expression rates were 26.7%,85.7% and 76.7%,there was statistically significant difference among the three groups（χ2=19.368,P0.001）.The FRα positive expression rate of HSIL and SCC group was higher than control,P0.05,but the positive expression rate between HSIL and SCC groups showed no significant difference,P0.05.The HSIL detection rate in FRα positive cases was 34.0%,which was higher than HPV（27.4%）but similar to TCT（33.3%）.FRα immunohistochemical detection sensitivity and specificity of HSIL and SCC were 76.2% and 93.3%,and the area under the ROC curve was 0.848,higher than HPV and TCT.The connection in series between TCT and FRα test is the best in the two-two joint detection.Conclusion Frozen immunohistochemical detection of FRα protein expression might be used as objective molecular marker for improving the detection rate of HSIL.