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目的探讨人类染色体端粒酶RNA(hTERC)基因扩增在宫颈癌发生发展中的作用及其对CIN2及以上病变筛查的临床意义。方法应用荧光原位杂交(FISH)法检测17例宫颈癌、39例CIN3、7例CIN2、14例CIN1及33例慢性宫颈炎患者宫颈脱落细胞hTERC基因扩增情况,同时对检测hTERC基因异常扩增与宫颈液基薄层细胞学检查(TCT)和高危型HPV-DNA检测诊断CIN2及以上病变的特异性和敏感性进行比较。结果 hTERC基因在慢性宫颈炎、CIN1、CIN2、CIN3及宫颈癌中的异常扩增率分别为18.19%、14.29%、35.29%、71.79%和94.12%,差异有统计学意义(χ2=41.415,P=0.000)。其中,慢性宫颈炎组和CIN1组hTERC基因扩增率比较,差异无统计学意义(P=1.000),但均显著低于CIN2、CIN3组和宫颈癌组(P=0.001)。而且,检测宫颈脱落细胞hTERC基因扩增诊断CIN2及以上病变的敏感性为68.49%(50/73),特异性为86.21%(50/58),而TCT诊断CIN2及以上病变的敏感性为63.01%(46/73),特异性为74.19%(46/62);高危型HPV-DNA检测诊断CIN2及以上病变的敏感性为90.41%(66/73),特异性为62.26%(66/106)。结论 hTERC基因扩增在宫颈癌的发生发展中起重要作用。FISH检测宫颈脱落细胞中hTERC基因扩增在一定程度上可反映CIN2及以上病变存在,可弥补TCT和HPV检测的不足。
Objective To investigate the role of human telomerase RNA (hTERC) gene amplification in cervical carcinogenesis and its clinical significance in screening CIN2 and above lesions. Methods Fluorescence in situ hybridization (FISH) was used to detect the amplification of hTERC gene in cervical exfoliated cells in 17 cases of cervical cancer, 39 cases of CIN3, 7 cases of CIN2, 14 cases of CIN1 and 33 cases of chronic cervicitis. Meanwhile, Compared with cervical cytology thin layer cytology (TCT) and high-risk HPV-DNA testing for the diagnosis of CIN2 and above lesions specificity and sensitivity were compared. Results The abnormal amplification rates of hTERC gene in chronic cervicitis, CIN1, CIN2, CIN3 and cervical cancer were 18.19%, 14.29%, 35.29%, 71.79% and 94.12% respectively, with significant difference (χ2 = 41.415, P = 0.000). Among them, the rate of hTERC gene amplification in chronic cervicitis group and CIN1 group was not significantly different (P = 1.000), but significantly lower than that in CIN2, CIN3 group and cervical cancer group (P = 0.001). In addition, the sensitivity and specificity of detecting hTERC gene amplification in cervical exfoliated cells for the diagnosis of CIN2 and above were 68.49% (50/73) and 86.21% (50/58), respectively, while the sensitivity of TCT in diagnosing CIN2 and above lesions was 63.01 % (46/73), specificity was 74.19% (46/62). The sensitivity and specificity of high-risk HPV-DNA testing for diagnosis of CIN2 and above lesions were 90.41% (66/73) and 62.26% ). Conclusion The hTERC gene amplification plays an important role in the development of cervical cancer. FISH detection of cervical exfoliated cells hTERC gene amplification to a certain extent, reflect the presence of CIN2 and above lesions, TCT and HPV can make up for lack of detection.