人类端粒酶逆转录酶hTERT Ki-67及p27^kipl在嗜铬细胞瘤组织的表达及意义研究

目的 研究人端粒酶逆转录酶（hTERT）、Ki-67及p27^kipl的表达在嗜铬细胞瘤发生与发展中的作用和作为预测生物学行为标志物的价值。方法 采用免疫组织化学方法检测hTERT、Ki-67及p27^kipl在2000-2004年广西医科大学第一附属医院病理科的45例嗜铬细胞瘤和神经节细胞瘤及9例正常肾上腺组织中的表达。结果 hTERT蛋白的表达在良性（3／31例）和可疑恶性（6／7例）以及良性与恶性肿瘤（5／7例）间的差异均有统计学意义（P〈0.01）。31例良性肿瘤中26例未检测到Ki-67，而恶性肿瘤和可疑恶性肿瘤均为阳性；Ki-67与hTERT的表达呈正相关性（r=0．544，P〈0．01）。恶性和可疑恶性肿瘤中未检测到p27^kipl，5例良性肿瘤为阳性，所有正常肾上腺髓质标本均可检测到p27^kipl的表达。p27^kipl与hTERT的表达无相关性。结论 端粒酶的激活在恶性嗜铬细胞瘤和神经节细胞瘤的发生发展中起着重要作用，在细胞周期调控中端粒酶可能存在不同的激活途径。hTElit和Ki-67的检测可作为鉴别良恶性嗜铬细胞瘤的手段。     

人类端粒酶逆转录酶mRNA和蛋白在嗜铬细胞瘤中的表达及其意义

目的研究人类端粒酶逆转录酶（hTERT）在嗜铬细胞瘤中的表达及其作为预测生物学行为标志物的价值。方法采用原位杂交方法测定hTERT mRNA在45例嗜铬细胞瘤和副神经节瘤和9例正常肾上腺髓质中的表达；免疫组织化学方法检测hTERT蛋白的表达水平。结果hTERT mRNA在5例恶性（5／7）和5例可疑恶性（5／7）肿瘤中表达，表达均高于良性肿瘤（3／31），差异有统计学意义（P〈0．01）；hTERT蛋白的表达在良性（3／31）和可疑恶性（6／7）以及恶性（5／7）差异有统计学意义（P〈0．01）；9例正常肾上腺髓质细胞中未发现hTERT mRNA和蛋白的表达；肿瘤组织hTERT蛋白和mRNA的表达存在正相关性（r=0．951，P〈0．01）；hTERT蛋白和mRNA的表达与临床因素，如性别、肿瘤大小和血压无关联。结论hTERT mRNA和蛋白检测对良、恶性嗜铬细胞瘤和副神经节瘤的鉴别诊断有重要临床意义。     

肿瘤标记物在恶性嗜铬细胞瘤诊断和治疗中的研究进展

HER2、VEGF、hTERT、HSP90、Ki-67是与嗜铬细胞瘤密切相关的肿瘤标记物,其过度表达可作为临床上鉴别良性及恶性嗜铬细胞瘤的参考指标.近年来,针对肿瘤标记物的靶向性治疗逐渐成为研究热点.临床试验证明,用VEGF的靶向性药物舒尼替尼治疗恶性嗜铬细胞瘤可收到很好的疗效.曲妥珠单抗、Gamitrinibs以及针对肿瘤标记物的基因治疗亦为治疗恶性嗜铬细胞瘤带来了希望.     

ERBB2、p-ERK、p-AKT、p-JNK在嗜铬细胞瘤中的表达及意义

用免疫组织化学染色方法检测表皮生长因子受体2(ERBB2)在8例恶性嗜铬细胞瘤和31例良性嗜铬细胞瘤组织中的表达.用Western印迹法检测5例ERBB2表达阳性的嗜铬细胞瘤和5例ERBB2表达阴性的嗜铬细胞瘤组织中细胞外信号调节激酶(ERK)、蛋白激酶B(AKT)、c-Jun氨基端激酶(JNK)信号分子的激活情况.结果 提示ERBB2蛋白在恶性嗜铬细胞瘤中高表达(P＜0.01)且可能通过丝裂原活化蛋白激酶(MAPK)/ERK途径,磷脂酰肌醇3激酶(PBK)/AKT途径以及应激活化蛋白激酶(SAPK)/JNK途径导致恶性嗜铬细胞瘤的发生.     

hTERT、Sp1、c-myc在良恶性胰岛β细胞瘤中的表达差异

目的检测人端粒酶逆转录酶(hTERT)、刺激蛋白1(Sp1)和原癌基因转录因子(c-myc)在良、恶性胰岛β细胞瘤和正常胰岛β细胞组织中的表达,探讨三者与胰岛β细胞瘤的关系,为临床鉴别良、恶性胰岛β细胞瘤和判断预后提供理论依据。方法用免疫组化方法检测hTERT、Sp1、c-myc在27例良性、16例恶性胰岛β细胞瘤和20例正常胰岛β细胞组织中的表达,并行相关性分析。结果 hTERT、Sp1、c-myc在恶性胰岛β细胞瘤中的阳性表达率分别为81.2%、75.0%、87.5%,在良性胰岛β细胞瘤中的阳性表达率分别为25.9%、29.6%、14.8%,在正常胰岛β细胞组织中没有表达。hTERT、Sp1和c-myc在良、恶性胰岛β细胞瘤的表达差异均有统计学意义(P均<0.05),且在恶性胰岛β细胞瘤的表达明显高于良性胰岛β细胞瘤和正常胰岛β细胞组织;hTERT与Sp1、c-myc的表达呈明显正相关(r分别为0.992、0.893,P均<0.01)。结论端粒酶的激活在良、恶性胰岛β细胞瘤的发生发展中起重要作用。联合检测hTERT、Sp1和c-myc的表达可作为鉴别良、恶性胰岛β细胞瘤的手段。     

肽处理相关基因在良恶性嗜铬细胞瘤鉴别中的意义

用GeXP(基因表达谱分析)方法,对16例良性嗜铬细胞瘤、14例恶性嗜铬细胞瘤患者的基因表达进行定量分析,发现肽处理相关基因在恶性嗜铬细胞瘤组表达低于良性嗜铬细胞瘤组表达,其中QPCT、HSPA4L、RNF6、RNF128基因表达较低可能提示嗜铬细胞瘤的恶性潜能更大.     

端粒酶及端粒酶逆转录酶在良、恶性胸腔积液中的表达及意义

目的 研究端粒酶及端粒酶逆转录酶(hTERT)在良、恶性胸腔积液中的表达,为临床诊断提供实验依据.方法 选择21例恶性胸腔积液(恶性组)及23例良性胸腔积液患者(良性组),应用重复序列扩增法-ELISA(TRAP-EUSA)法及免疫组化方法检测积液中端粒酶、hTERT及癌胚抗原(CEA)表达.结果 良性组和恶性组端粒酶表达阳性率分别为39.13%、76.19%,P<0.01;hTERT表达阳性率分别为0、80.95%,P<0.01.hTERT检测恶性胸腔积液的特异度(100%)显著高于端粒酶(60.87%),敏感度(80.95%)显著高于CEA(47.62%).结论 hTERT检测恶性胸腔积液的敏感度和特异度均较高,且其免疫组化检测方法简便易行,值得临床借鉴.     

197例嗜铬细胞瘤临床分析

目的提高嗜铬细胞瘤的诊治水平。方法回顾性分析郑州大学第一附属医院1986～2005年所有病理诊断为嗜铬细胞瘤的197例患者的临床资料。结果197例患者均经手术治疗。良性嗜铬细胞瘤184例,恶性13例;肾上腺原发肿瘤171例,异位嗜铬细胞瘤24例,多发内分泌腺瘤（MEN）Ⅱ（嗜铬细胞瘤伴甲状腺髓样癌）2例。结论完善检查手段可提高嗜铬细胞瘤的检出率,确诊需病理检查,手术是根本的治疗方法。     

骨巨细胞瘤组织中Bax、p27kipl的表达及意义

采用免疫组化法检测60例骨巨细胞瘤（GCTB）标本中Bax及p27^（kip1）蛋白。不同病理分级的GCTB中Bax和p27^（kip1）的阳性表达率相比,P〈0.05;不同预后的GCTB中p27^（kip1）阳性表达率相比,P〈0.05。认为Bax及p27^（kip1）的表达与GCTB的病理分级相关,但Bax不能作为判断GCTB预后的指标,而p27^（kip1）则可作为判断预后的指标之一。     

肾上腺外嗜铬细胞瘤25例临床分析

目的 分析肾上腺外嗜铬细胞瘤的发病情况，病理特征及诊断方法，探讨治疗措施。方法 通过对81例经手术与病理证实的嗜铬细胞瘤进行回顾性分析。结果 81例嗜铬细胞瘤患者中，经手术与病理证实的肾上腺外嗜铬细胞瘤25例，占同期收治嗜铬细胞瘤的30．9％。病人的临床表现除特殊部位肿瘤外与肾上腺髓质嗜铬细胞瘤相似。结论 肾上腺外嗜铬细胞瘤临床表现与生化诊断与肾上腺髓质嗜铬细胞瘤相似，其恶性者较肾上腺髓质嗜铬细胞瘤明显增多，定位诊断以^131I-MIBG为特异，治疗以手术最佳。     

Expression profile of the telomeric complex discriminates between benign and malignant pheochromocytoma

Telomerase, a ribonucleoprotein complex that includes the telomerase RNA component, the telomerase-associated protein (TP1), the telomerase catalytic subunit (hTERT), and the heat shock protein 90 (HSP90), is closely related to the malignant potential of human tumors. In pheochromocytomas (PC) it is very difficult to predict malignant potential by conventional histology or immunohistochemical and molecular markers. To test whether the expression of telomerase subunits is reflected in the malignant transition of PCs, we determined their mRNA and/or protein expression in 28 benign and nine malignant PCs and compared the results with telomerase activity. RT-PCR analysis revealed that TP1 was ubiquitously expressed. The telomerase RNA component was found in all malignant (100%) and in 13 of 28 (46%) benign PCs. In contrast, hTERT was clearly associated with aggressive biological behavior. All of the malignant (100%), but only two of 28 benign (7%) PCs expressed hTERT. HSP90 was increased in malignant PCs, but was also expressed at a lower level in benign tumors. High telomerase activity was measurable in hTERT-positive tissues only. Our data indicate that hTERT, HSP90, and telomerase activity are up-regulated in malignant cells of the adrenal medulla. The common expression of hTERT and telomerase activity thus represents an additional prognostic marker that may identify more aggressive tumors.     

The diagnosis and management of malignant phaeochromocytoma and paraganglioma

Malignant phaeochromocytomas are rare tumours accounting for ~10% of all phaeochromocytomas; the prevalence of malignancy among paragangliomas is higher, especially those associated with succinate dehydrogenase subunit B gene mutations. Although a subset of these tumours has metastatic disease at initial presentation, a significant number develops metastases during follow-up after excision of an apparently benign tumour. Clinical, biochemical and histological features cannot reliably distinguish malignant from benign tumours. Although a number of recently introduced molecular markers have been explored, their clinical significance remains to be elucidated from further studies. Several imaging modalities have been utilised for the diagnosis and staging of these tumours. Functional imaging using radiolabelled metaiodobenzylguanidine (MIBG) and more recently, (18)F-fluorodopamine and (18)F-fluorodopa positron emission tomography offer substantial sensitivity and specificity to correctly detect metastatic phaeochromocytoma and paraganglioma and helps identify patients suitable for treatment with radiopharmaceuticals. The 5-year mortality rate of patients with malignant phaeochromocytomas and paragangliomas greater than 50% indicates that there is considerable room for the improvement of currently available therapies. The main therapeutic target is tumour reduction and control of symptoms of excessive catecholamine secretion. Currently, the best adjunctive therapy to surgery is treatment with radiopharmaceuticals using (131)I-MIBG; however, this is very rarely curative. Chemotherapy has been used for metastatic disease with only a partial and mainly palliative effect. The role of other forms of radionuclide treatment either alone or in combination with chemotherapy is currently evolving. Ongoing microarray studies may provide novel intracellular pathways of importance for proliferation/cell cycle control, and lead to the development of novel pharmacological agents.     

Thyroid carcinomas that express telomerase follow a more aggressive clinical course in children and adolescents

With each cell division, DNA is lost from the telomeres, limiting the number of divisions, and leading to senescence. Malignant tumors maintain immortality by expressing a specific DNA repair enzyme, telomerase, that replaces this DNA. We hypothesized that tumors which express telomerase would have the highest recurrence risk and we tested this by determining telomerase expression in 27 papillary thyroid carcinomas (PTC), 5 follicular thyroid carcinomas (FTC) and 13 benign thyroid lesions from children and adolescents. Patients were 6-21 yr of age (mean+/-SE=16.6+/-4.1 yr) and followed from 0-14.1 yr (mean+/-SE=4.71+/-3.5 yr). Original tumors were sectioned, and immunostained for telomerase. Telomerase-specific staining was determined by two independent, blind examiners and graded from absent (Grade 0) to intense (Grade 3). Telomerase was detected in a similar majority of benign (11/13, 85%) and malignant tumors (24/32, 75%). However, the intensity of telomerase expression was greater among FTC (mean+/-SE=2.4+/-0.5 relative intensity) followed by PTC (mean+/-SE=1.9+/-1.0 relative intensity) and benign tumors (mean+/-SE=1.8+/-1.0 relative intensity). Autoimmune lesions had lower telomerase expression (mean+/-SE=1.25+/-0.5 relative intensity) compared to FTC (p=0.01), PTC (p=0.06) and benign lesions (p=0.15). Among PTC, 19 (70%) expressed telomerase, and 8 (30%) did not. Direct invasion (no.=4, 21%), distant metastasis (no.=2, 10%) and recurrence (no.=7, 37%) developed exclusively in PTC that expressed telomerase (p=0.02). Disease-free survival was also shorter for PTC that expressed telomerase (p=0.06). Recurrence developed in 1/2 (50%) FTC that expressed telomerase. We conclude that childhood thyroid cancers which express telomerase have an increased risk of tissue invasion, metastasis, and recurrence.     

p27kip1基因转移对食管癌细胞生存素表达和端粒酶活性的影响

背景：p27kip1是新近发现的一种抑癌基因，早期研究表明p27kip1基因转移能显著抑制食管癌细胞和人食管癌裸鼠移植瘤的生长，表明该基因疗法可能是食管癌治疗的新途径，但其抑癌机制尚未完全阐明。目的：研究p27kip1基因转移对食管癌细胞生存素（survivin）表达和端粒酶活性的影响。从而阐明p27kip1的抑癌机制，为p27kip1基因治疗食管癌提供理论依据。方法：将携带p27kip1基因的重组腺病毒（Ad—p27kip1）和LacZ重组腺病毒（Ad—LacZ）分别转染食管癌细胞系Eca9706，观察细胞形态变化。以免疫细胞化学染色和蛋白质印迹法检测p27kip1和生存素的表达．以端粒重复序列扩增程序（TRAP）聚合酶链反应（PCR）-酶联免疫吸附测定（ELISA）检测端粒酶活性。结果：经Ad—p27kip1转染后，Eta9706细胞变圆，呈葡萄串样聚集以致脱落。细胞p27kip1表达明显增强，生存素表达降低，端粒酶活性显著受抑制。结论：p27kip1基因抑制食管癌细胞生长的作用机制可能与下调生存素表达和抑制端粒酶活性有关。     

肺癌、良性实质性病变和正常肺组织端粒酶逆转录酶定位表达的研究

目的研究端粒酶在肺良、恶性病变和正常肺组织中表达的定位,以阐明端粒酶在上述疾病发病机制中的作用,以及在正常肺组织中的生物学意义。方法对38例肺癌、7例良性实质性病变及35例病灶旁正常肺组织标本用核酸原位杂交和免疫组织化学技术对端粒酶逆转录酶（hTERT）mRNA和蛋白质的定位表达进行了研究,同时与端粒酶活性进行了对比。结果肺癌、良性实质性病变和病灶旁正常肺组织端粒酶活性阳性分别为31/38、3/7、7/35（P<0.001）;肺癌组织癌细胞、肺良性实质性病变中的淋巴细胞、纤维母细胞、巨噬细胞等以及病灶旁正常肺组织小气道、细支气管上皮的部分细胞和少部分肺泡上皮细胞hTERT蛋白有阳性表达,在有淋巴小结的肺组织其生发中心可见hTERT表达,多数巨噬细胞也有hTERT阳性表达。hTERTmRNA所表达的细胞与免疫组织化学结果类似。肺癌hTERT免疫染色平均吸光度比较鳞癌A值比腺癌略高,Ⅲ期比Ⅰ期、Ⅱ期稍高,分化程度越低A值也越高,但P>0.05。结论(1)端粒酶除了参与肺癌的发病机制外,也参与肺良性实质性病变发生发展。（2）端粒酶对于维持正常肺组织支气管上皮细胞、肺泡巨噬细胞和淋巴细胞的功能可能有重要的生物学意义。(3)端粒酶是一种增殖指标,而非肺癌的恶性特异性标志,端粒酶作为肺癌诊断标记物时可能有一定的假阳性。