水泡状胎块中p57、p53及Ki-67的表达及意义

目的：探讨p57、p53和Ki-67的表达在水泡状胎块病理诊断与鉴别诊断中的作用和意义。方法：应用SP法检测74例完全性水泡状胎块（complete hydatidiform mole,CHM）、72例部分性水泡状胎块（partial hydatidiform mole,PHM）和79例水肿性流产胎（hydropic abortion,HA）三组病变组织中p57、p53和Ki-67的表达情况,以正常成熟胎盘（normal mature placenta,NMP）10例为正常对照。同时分析患者的年龄及血中HCG浓度在鉴别各组疾病中的价值。结果：p57在CHM组中的表达明显低于PHM组、HA组及NMP组（P〈0.01）;p53和Ki-67在PHM组和CHM组的阳性表达高于HA及NMP组（P〈0.05）。完全性水泡状胎块的发病高峰在21～25岁,部分性水泡状胎块发病高峰在25～30岁,水肿性流产胎发病高峰在30～35岁。PHM组患者血中β-HCG含量高于CHM组,CHM组又高于HA组。结论：Ki-67和p53的表达对于鉴别水泡状胎块与流产水肿绒毛有重要价值,但对于区别完全性与部分性水泡状胎块其价值有限;而p57蛋白在CHM和PHM的表达和分布有明显差异,可作为水泡状胎块分型诊断的客观辅助指标。HA、PHM和CHM的发病高峰在不同的年龄阶段,可作为辅助鉴别诊断的参考。患者血中HCG的浓度是鉴别水泡状胎块与水肿性流产胎重要的临床客观辅助指标。

Expression of gene p57,p53 and Ki- 67 in hydatidiform moles

Objectives：To study the expression of gene p57,p53 and Ki-67 in hydatidiform moles and their effects on differential diagnosis of complete hydatidiform moles（CHM） from partial hydatidiform moles（PHM） and hydropic abortions（HA）.Method：74 cases of CHM,72 PHM and 79 HA were evaluated by immunohistochemistry of formalin- fixed tissues using a monoclonal antibody against p57,p53 and Ki- 67 protein,while 10 normal mature placentas（NMP） were selected as the control group.Results：In all 72 cases of PHM,79 HA and 10 NMP,nuclear p57 was strongly expressed.In CHM,p57 expression was absent.Expression of p53 and Ki- 67 in HM was stronger than in HA.Conclusion：The immunohistochemical analysis for p57 expression is a useful tool for the differential diagnosis to distinguish CHM from PHM and HA.Ki- 67 and p53 are useful tools to distinguish HA from HM.