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目的 研究h-TERC及c-MYC的表达及其与HPV感染、宫颈病变的相关性,借此寻找更为有效且实用的宫颈癌筛查方法。方法 选取2010年8月至2011年12月在上海交通大学医学院附属仁济医院妇科门诊就诊者共1000例,分别行TCT检测、HPV-DNA检测(SPR法)、h-TERC和c-MYC基因检测(FISH法),对任一结果阳性者行阴道镜及宫颈病理活检,以病理结果为诊断金标准。结果 1000例中TCT异常占10.6%;HPV异常占11.2%;h-TERC基因异常占6.4%;c-MYC基因异常占5.6%。213例按要求行阴道镜及宫颈活检,结果提示宫颈慢性炎、CINⅠ、CINⅡ、CINⅢ及宫颈癌发生率分别为:74.6%、14.6%、6.6%、3.3%和0.9%。相应的h-TERC阳性率分别为18.2%、58.1%、64.3%、85.7%、100.0%;c-MYC阳性率分别为20.1%、35.5%、50.0%、57.1%、100.0%;HPV阳性率分别为45.3%、67.7%、78.6%、85.7%、100.0%。随着病理学等级的上升,HPV感染者中h-TERC和c-MYC的阳性率也升高。结论 h-TERC、c-MYC基因扩增与宫颈细胞组织学异常及HPV感染密切相关,可能是较好的宫颈癌筛查指标。
Objective To study the expression of h-TERC and c-MYC and their correlation with HPV infection and cervical lesions in order to find a more effective and practical cervical cancer screening method. Methods A total of 1000 gynecological outpatients from Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from August 2010 to December 2011 were selected for TCT, HPV-DNA (SPR), h-TERC and c-MYC Gene test (FISH), colposcopy and cervical biopsy of any positive results, pathological results for the diagnosis of gold standard. Results 1000 cases of TCT abnormalities accounted for 10.6%; HPV abnormalities accounted for 11.2%; h-TERC gene abnormalities accounted for 6.4%; c-MYC gene abnormalities accounted for 5.6%. Colposcopy and cervical biopsy were performed on 213 cases. The results showed that the incidence of chronic cervicitis, CINⅠ, CINⅡ, CINⅢ and cervical cancer were 74.6%, 14.6%, 6.6%, 3.3% and 0.9% respectively. The positive rates of h-TERC were 18.2%, 58.1%, 64.3%, 85.7% and 100.0%, respectively. The positive rates of c-MYC were 20.1%, 35.5%, 50.0%, 57.1% and 100.0% 45.3%, 67.7%, 78.6%, 85.7%, 100.0%. As the pathological grade increases, the positive rates of h-TERC and c-MYC in HPV-infected patients also increase. Conclusions The amplification of h-TERC and c-MYC genes is closely related to cervical cell histological abnormalities and HPV infection, which may be a good screening index for cervical cancer.