胆管癌组织中自发性细胞凋亡和bcl-2/bax表达的状况及意义

目的：研究胆管癌组织中自发性细胞凋亡和bcl-2/bax基因表达的状况及意义。方法：TUNEL法原位检测凋亡细胞，免疫组化检测bcl-2和bax蛋白表达。结果：40例胆管癌标本自发性细胞凋亡指数（AI）的中位值为7．89％，高／中分化和无淋巴结转移胆管癌AI分别高于低分化和淋巴结转移者（P＜0．01），胆管癌组织bcl-2和bax蛋白表达率分别为７２．５％（２９／４０）和５７．５％（２３／４０），与癌旁正常胆管壁组织比较差异显著（Ｐ＜０．０１），高／中分化胆管癌bcl-2蛋白表达率高于低分化胆管癌（P＜0．01），bcl-2表达阳性胆管癌AI低于阴性，bax阳性高于阴性（P＜0．01），结论：胆管癌细胞仍保胃凋亡机制，bcl-2凋亡途径参与了胆管癌的发生，发展过程，AI和bcl-2蛋白表达可作为判断胆管癌恶性程度的指标。

Spontaneous apoptosis and bcl-2/bax expressions in cholangiocarcinoma and their sig-nificance

Objective To investigate the spontaneous apoptosis and expressions of bcl 2/bax in cholangiocarcinoma and their significance. Methods TUNEL technique and immunohistochemistry were carried out to determine apoptotic cells in situ and the expressions of bcl 2/bax proteins respectively in 40 specimens of cholangiocarcinoma tissues with pathological confirmation. Results The median of spontaneous apoptotic indices (AIs) was 7.89% in 40 cases of cholangiocarcinomas. The AIs of the cases well/moderately differentiated and without lymph node metastasis were significantly higher than those in cases poorly differentiated and with lymph node metastasis respectively ( P <0.01). bcl 2 protein was expressed in 29/40 (72.5%) of carcinoma samples and 0/12 in paracancerous normal bile ducts, while the positive rate of bax protein was 57.5% (23/40) for the former and 83.3% (10/12) for the latter ( P <0.01). Furthermore, well/moderately differentiated carcinomas more frequently expressed bcl 2 compared with poorly differentiated cases ( P <0.01). Finally, bcl 2 expression was inversely, and bax expression was positively related to AI ( P <0.01). Conclusion Apoptosis mechanism remains in cholangiocarcinoma cells, and the bcl 2 mediated apoptotic pathway plays a role in the occurrence and progression of this carcinoma. AI and bcl 2 expression are useful to predict the malignant grade of cholangiocarcinoma.