萎缩性胆囊炎胆囊上皮细胞增殖活性及其与临床特征的关系

目的探讨增殖细胞核抗原（PCNA）、Ki-67的表达与萎缩性胆囊炎患者临床特征的关系。方法采用免疫组化方法对60例萎缩性胆囊炎胆囊切除标本进行PCNA、Ki-67定量和定性检测，与单纯性胆囊炎、原发性胆囊癌进行比较。并进一步对萎缩性胆囊炎患者两项指标与临床特征（性别、年龄、病程长短、胆囊壁厚度及结石大小）的关系进行分析。结果萎缩性胆囊炎PCNA阳性指数、Ki-67阳性率与单纯性胆囊炎、原发性胆囊癌之间的差异均有统计学意义（均P〈0．01）。萎缩性胆囊炎患者中，年龄≥50岁、病程≥5年、胆囊壁厚度≥0．40cm和胆囊结石直径≥1．0cm者PCNA阳性指数、Ki-67阳性率均显著高于年龄〈50岁、病程〈5年、胆囊壁厚度〈040cm和结石直径〈1．0cm者（均P〈0．01），不同性别者之间的差异则无统计学意义（P〉0．05）。萎缩性胆囊炎患者Ki-67表达阳性者的PCNA阳性指数显著高于Ki-67表达阴性者（P〈0．01）。结论萎缩性胆囊炎患者具有高龄、病程长久、胆囊壁明显增厚、结石直径大中一个或数个高危因素会增加患者胆囊上皮细胞增殖活性指标（PCNA、Ki-67）的表达，从而增加萎缩性胆囊炎癌变的危险性。

Relationship between proliferative activity of biliary epithelial cells and clinical features of contracted cholecystitis

Objective To evaluate the relationships between proliferative activity of biliary epithelial cells and the clinical features of contracted cholecystitis.Methods Expression of proliferative cell nuclear antigen （PCNA） and Ki-67 was detected by immunehistochemical En-Vision method in 60 surgical specimens of contracted cholecystitis; its correlation with clinical features of patients were analyzed. Results Higher PCNA LI was associated with older age （≥50y）, longer disease history （≥5y）, thicker gallbladder wall （≥0.4cm） and larger gallstone （≥ 1.0cm） in patients with contracted cholecystitis. There was no significant association of PCNA and Ki-67 expression with gender of patients. Patients with positive expression of Ki-67 had a significantly higher PCNA LI than those with negative Ki-67 expression. Conclusion Contracted cholecystitis patients with older age, longer disease course, thicker gallbladder wall and large gallstone are associated with higher expression of PCNA and Ki-67,therefore have higher risk for cancerous transformation of contracted cholecystitis.