Calretinin和PGP9.5在先天性巨结肠诊断中的应用

Calretinin and PGP9. 5 used in combination for diagnosis of Hirschsprung's disease

目的:探讨Calretinin和PGP9.5在先天性巨结肠(HD)临床病理诊断中的应用。方法:将2015年1月至2017年12月在广东省妇幼保健院确诊的48例HD患者和20例非HD患者作为研究对象,分别在扩张段HD和狭窄段HD、非HD组织中行Calretinin和PGP9.5免疫组化染色。结果:48例HD扩张段中,40例可见成熟神经节细胞,8例见不成熟神经节细胞,Calretinin和PGP9.5均表达阳性。HD狭窄段Calretinin阳性1例,阴性47例;PGP9.5显示增粗神经纤维46例,无增粗2例。20例非HD中Calretinin表达阳性19例,1例神经纤维阳性,未见神经节细胞;PGP9.5均呈阳性表达。狭窄段HD与非HD中Calretinin阳性率、PGP9.5标记的增粗神经纤维比较,差异有统计学意义(P<0.05)。初始诊断灵敏度和特异度分别为95.65%(95%CI,0.84-0.99)和95%(95%CI,0.73-0.997)。结论:病理形态学诊断联合Calretinin和PGP9.5检测对于HD的诊断和鉴别诊断更加准确。

Objective: To investigate the value of Calretinin and PGP9. 5 used in combination for clinicopathological diagnosis of Hirschsprung's disease( HD). Methods: Forty-eight HD patients and 20 non-HD others diagnosed at Guangdong Women and Children's Hospital between January 2015 and December 2017 were included in this study. Calretinin and PGP9.5 immunohistochemical staining were used to examine the dilated and narrowed colon segments in HD and non-HD colon segment. Results: There were 48 cases of Hirschsprung' s disease. Of the dilated colon segments,mature ganglion cells were seen in 40 segments and immature ganglion cells in 8,all tested positive for Calretinin and PGP9.5. Of the narrowed colon segments,one was positive and 47 negative for Calretinin,and PGP9.5 revealed hypertrophic nerve in 46 while normal nerve in 2 cases. In 20 nonHD patients,19 were positive for Calretinin in ganglion cells and nerve fibers,while one was positive in nerve fibers but not in ganglion cell. All these non-HD patients tested positive for PGP9.5. The difference in Calretinin positivity and PGP9.5 findings for hypertrophic nerve fibers between the narrowed segment in HD and non-HD tissues were statistically significant( P < 0. 05). The sensitivity and specificity of the initial diagnostic were 95.65%( 95% CI,0. 84-0. 99) and 95%( 95% CI,0. 73-0. 997),respectively. Conclusion: Pathomorphology combined with Calretinin and PGP9. 5 can be more accurate in the diagnosis and differential diagnosis of Hirschsprung's disease.