结直肠腺瘤癌变细胞凋亡及免疫组化研究

目的了解细胞增殖与凋亡相关基因表达在结直肠腺瘤癌变转化过程中的作用，并寻求判断腺瘤癌变的分子生物学指标。方法应用免疫组化法检测61例结直肠腺瘤癌变标本中P53、bcl-2、Fas、bax在腺瘤癌变区及腺瘤轻、重度异型增生区的表达；以ki-67指数和TUNEL法计量细胞增殖率及凋亡率。结果61例结直肠腺瘤癌变标本中P53蛋白在腺瘤癌变区、重度异型增生区及轻度异型增生区的表达分别为67．2％，57．4％和19．7％；bcl-2蛋白的表达分别为77．1％，80．3％和49．2％；腺瘤癌变区、重度异型增生区及轻度异型增生区的平均ki-67指数分别为38．4％、36．5％和16．1％；平均细胞凋亡指数分别为2．2％，1．9％及0．5％。P53蛋白、bcl-2蛋白的表达和ki-67指数、细胞凋亡指数在腺瘤重度异型增生区与癌变区比轻度异型增生区显著增高（P〈0．05）。结论凋亡抑制和增殖异常共同参与了腺瘤癌变的转化过程。重度异型增生是一类具有明显癌变倾向的病变，检测上述蛋白可作为腺瘤癌变早期诊断的重要参考指标。

Apoptotic and immunohistochemical study on colorectal adenoma with malignant transformation

Objective It is to understand the role of proliferation and apoptosis related gene expression in the course of colorectal adenoma with malignant transformation and to explore the molecular biology index judging adenoma with malignant transformation, Methods The expression of P53, bcl- 2, Fas, bax at malignant transformation district and mild and severe dysplasia districts of adenoma in 61 cases of colorectal adenoma with malignant transformation were detected with immunohistochemistry method, The rates of proliferation and apoptosis were calculated with ki - 67 exponent and TUNEL method, Results The expression rate of P53 protein at malignant transformation district, mild dysplasia district and severe dysplasia district in 61 cases of colorectal adenoma with malignant transformation was 67,2 %, 57.4 % and 19.7 % respectively, and the expression rate of bcl - 2 protein was 77, 1%, 80.3 % and 49.2 % respectively, The mean ki - 67 exponent of malignant transformation district, mild dysplasia district and severe dysplasia district was 38,4 %, 36, 5 % and 16, 1% respectively, and the mean apoptosis exponent was 2,2 %, 1,9 % and 0.5 % respectively, The expression of P53 protein and bcl - 2 protein, the ki - 67 index and apoptosis exponent in severe dysplasia district and malignant transformation district were significantly higher than that in mild dysplasia district （ P 〈 0.05 ）, Conclusion Both apoptosis inhibition and abnormal proliferation participate the malignant transformation course of adenoma, Severe dysplasia is a kind of affection possessing obvious canceration tendency, Detecting above proteins can be as important referred index in the early diagnosis of adenoma malignant transformation.