结直肠锯齿状腺瘤、传统腺瘤及结直肠癌中端粒酶、p53及Ki-67的表达比较

背景与目的：结直肠锯齿状腺瘤(serrated adenoma，SA)是2000年被WHO正式命名为独立的一种疾病，与传统腺瘤(traditional adenoma，TA)和结直肠癌(colorectal carcinoma，CRC)比较有其独特的性质。本研究通过对锯齿状腺瘤、传统腺瘤和结直肠癌组织中端粒酶、p53及Ki-67的免疫组化表达比较，探讨锯齿状腺瘤与普通腺瘤的恶性潜能异同及与大肠腺癌的关系。方法：运用免疫组化MaxVision法对37例锯齿状腺瘤、36例传统腺瘤，34例结直肠癌组织标本进行端粒酶、p53及Ki-67检测。结果：端粒酶在锯齿状腺瘤、传统腺瘤和结直肠癌组间差异有统计学意义(P<0.05)，结直肠癌组阳性率高于锯齿状腺瘤组(P<0.05)，锯齿状腺瘤组高于传统腺瘤组(P<0.01)；Ki-67在锯齿状腺瘤与传统腺瘤两组差异无统计学意义(P>0.05)，结直肠癌组的阳性率则明显高于锯齿状腺瘤和传统腺瘤组(P<0.01)；结直肠癌组p53阳性率高于传统腺瘤组(P<0.01)，传统腺瘤组高于锯齿状腺瘤组(P<0.01)。结论：端粒酶、p53及Ki-67检测显示：锯齿状腺瘤是一种具有较强活性的腺瘤，端粒酶的激活可能在其癌变过程中起一定作用。

Comparison of telomerase,p53 and Ki-67 expression on colorectal serrated adenoma,traditional adenoma and colorectal cancer

Background and purpose: Colorectal serrated adenoma (SA) was officially named in 2000 by the WHO as a separate disease, with unique properties compared with traditional adenoma (TA), and its relationship with colorectal cancer (CRC) is very concerned. This study was to analyze and compare the telomerase, p53 and Ki-67 immunohistochemical expression on the tissues of SA, TA and CRC. Methods: Immunohistochemistry was adopted to analyze the expression of telomerase, p53, and Ki-67 in 37 cases of SA, 36 cases of TA and 34 cases of CRC. Results: The p53-positive percentage of SA was significantly lower than that of TA (P<0.01), and the p53-positive percentage of TA was significantly lower than that of CRC (P<0.01). No significant difference of Ki-67 expression was found between SA and TA, and the Ki-67-positive percentage of SA and TA was lower than that of CRC (P<0.01). The telomerasepositive percentage of TA was significantly lower than that of SA (P<0.01), and the telomerase-positive percentage of SA was significantly lower than that of CRC (P<0.05). Conclusion: Telomerase, P53, and Ki-67 immunohisto chemical analysis indicated that SA is a kind of proliferative adenoma, and telomerase activation may play a role in the cancer process.