人端粒酶逆转录酶在胃癌及其癌前病变中的表达

Expression and the significance of telomerase reverse transcriptase in gastric carcinomas and precancerous lesions

目的 :通过检测胃癌及其癌前病变中端粒酶逆转录酶 (humantelomerasereversetranscriptase ,hTERT)蛋白的表达 ,探讨其作为胃癌标志物在评价胃癌癌前病变中的价值。方法 :采用抗人hTERT单克隆抗体 ,以免疫组化法检测 2 1例胃良性病变 (慢性浅表性胃炎 )、98例胃癌前病变 (中重度肠上皮化生 74例、中重度异型增生 2 4例 )、73例胃癌 (早期胃癌 2 0例、进展期胃癌 5 3例 )标本hTERT的表达。结果 :胃癌组和癌前病变组hTERT阳性率分别为 84 .93%和 11.2 2 %,浅表性胃炎组无一例hTERT阳性。胃癌组hTERT阳性率明显高于癌前病变组(χ2 =92 .90 0 ,P =0 .0 0 0 ) ,而癌前病变组与浅表性胃炎组的阳性率在统计学上差异无显著性 (χ2 校正 =1.4 32 ,P =0 .2 32 )。在胃癌组中 ,进展期胃癌hTERT阳性率略高于早期胃癌 ,但统计学上差异无显著性 (χ2 校正 =0 .12 7,P =0 .72 1) ;但其阳性强度比较差异有显著性 (χ2 =14 .5 4 1,P =0 .0 0 2 )。 33例癌旁肠上皮化生组织的hTERT阳性率为 5 1.5 2 %,明显高于非癌肠上皮化生组的 10 .81%(χ2 =2 1.118,P =0 .0 0 0 )。结论 :免疫组化检测hTERT高表达可以作为胃癌标志物 ,追踪hTERT阳性的胃癌癌前病变患者可能有助于早期发现胃癌。

Objective:To evaluate the value of human telomerase reverse transcriptase (hTERT) as a diagnostic marker. Methods:hTERT expressed in 53 cases of advanced gastric carcinoma, 20 of early gastric carcinoma, 24 of moderate and severe dysplasia,and 74 of moderate and severe intestinal metaplasia and 21 of chronic superficial gastritis were detected by hTERT specific monoclonal antibody based immunohistochemistry . Results: The positive rate of hTERT in advanced gastric carcinomas, early gastric carcinomas, moderate and severe dysplasia, moderate and severe intestinal metaplasia and chronic superficial gastritis were 86.79%,80.00%,12.50%,10.81%,and 0.00% respectively. The former two were significantly higher than the others(χ 2=92.900, P =0.000). The nuclei hTERT staining of carcinoma cells in advanced gastric carcinoma showed generally stronger than that in early gastric carcinoma(χ 2=14.541, P =0.002). The hTERT protein was detected in 17 of 33 cases of intestinal metaplasia adjacent to the gastric cancer, and the positive rate was 51.52%, which was significantly higher than that of non neoplastic intestinal metaplasia tissues(χ 2=21.118, P =0.000). Con clusion: The results indicate that increased hTERT expression might be a useful marker for diagnosis of gastric carcinoma, and a useful tool for predicting the malignant change potential of gastric precancerous lesions.