50例胆囊癌黏液组化与免疫组化观察

目的：探讨黏液分泌变化和肿瘤相关抗原表达对胆囊癌早期诊断及其预后判断的价值。方法：采用黏液组化和免疫组化染色对40例胆囊癌，10例胆囊腺瘤，10例慢性胆囊炎的黏液分泌和CEA，CA50，E－cad及PCNA表达进行检测。结果：胆囊癌与胆囊炎和腺瘤相比，分泌硫酸黏液明显减少，唾酸黏液显著增多（P＜0．05）。胆囊癌CEA，CA50阳性表达率显著高于腺瘤和胆囊炎组（P＜0．05），而E－cad阳性表达率明显降低，伴有转移者E－cad表达更低，胆囊癌PCNA LI高于胆囊炎和腺瘤组（P＜0．01），CEA，PCNA过度表达者其3年生存率显著降低（P＜0．01），E－cad过度表达者其3年生存率较阴性组明显增高（P＜0．05）。结论：黏液组化染色和CEA，CA50以及PCNA检测可能有助于胆囊腺瘤恶变和胆囊癌的早期诊断，且CEA PCNA和E－cad检测可作为胆囊癌预后判断的参考指标。

Gallbladder carcinoma and its prognostis:a mucohistochemical and immunohistochemical study of 50 cases

Purpose To explore the value of changes of mucous secretion and expression of carcinoma associated antigens in early diagnosis and prediction of prognosis of gallbladder carcinoma. Methods The secretive mucin and expression of CEA, CA50, E cad and PCNA were detected by mucohistochemistry and immunohistochemistry in 50 cases of gallbladder carcinomas, 10 gallbladder adenomas and 10 cholecystitis. Results There were significant decrease of sulphomucin and increase of sialomucin in gallbladder carcinomas ( P <0 05). The positive rates of CEA, CA50 and PCNA LI in gallbladder carcinomas were significantly higher than that of gallbladder adenomas and cholecystitis ( P <0 05). The positive rate of E cad in gallbladder carcinomas was significantly lower than that of gallbladder adenomas and cholecystitis ( P <0 05). Three years survival rate was significantly lower in gallbladder carcinomas with CEA and PCNA overexpression ( P <0 05), and three years survival rate in the patients with E cad positive tumors was higher than that of those with negative tumors ( P <0 05). Conclusions The detection of secretive mucin, CEA, CA50 and PCNA is useful for early diagnosis of malignant change in gallbladder adenomas and gallbladder carcinomas. Therefore, CEA, PCNA and E cad may be valuable in predicting prognosis of gallbladder carcinomas.