宫颈脱落细胞hTERC基因扩增的初步研究

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。

Preliminary study on genomic amplification of human telomerase RNA component in cytologic specimens from patients with cervical lesions

Objective To investigate the role of genomic amplification of the RNA component of human telomerase(hTERC)in canceration and progression of cervical cancer and to study the clinical value of detection of hTERC amplification on screening high grade cervical lesions(≥CIN2 lesions including CIN2,CIN3 and cervical cancer).Methods Amplification of hTERC was detected by fluorescence in situ hybridization(FISH)in cervical diseases including 17 cases of squamous cervical cancer,39 cases of CIN3,17 cases of CIN2,14 cases of CIN1 and 33 cases of chronic cervicitis.Compared with conventional liquid-based thin layer cytology(TCT)and higy risk HPV detection(HC2),the specificity and sensitivity of detection of hTERC amplification to diagnose high grade cervical lesions were also evaluated.Results The amplification rates of hTERC in chronic cervicitis,CIN1,CIN2,CIN3 and squamous cervical cancer were 18.19%、14.29%、35.29%、71.79% and 94.12%,respectively.Difference was statistically significant among the five groups(χ2 =41.415,P=0.000).The difference was not significant between chronic cervicitis and CIN1(P=1.000).But amplification rates of hTERC in chronic cervicitis and CIN1 was significantly lower than that in CIN2,CIN3 and squamous cervical cancer(P=0.001).Moreover,the specificity and sensitivity of detection of hTERC amplification to diagnose high grade cervical lesions were 86.21%(50/58)and 68.49%(50/73),whereas the specificity and sensitivity of TCT to diagnose high grade cercical lesions were 74.19%(46/62)and 63.01%(46/73).As for HC2,the specificity and sensitivity were 62.26%(66/106)and 90.41%(66/73).Conclusions The amplification of hTERC takes an important part in the pathogenesis of cervical cancer.Genomic amplification of hTERC in cytologic specimens has some value in predicting high grade cercical lesions.Detection of hTERC amplification can supply the gap of TCT and higy risk HPV detection(HC2)in screening cervical cancer.