星形细胞瘤中Ki-67,VEGF,bcl-2,cyclin-D1及p16的免疫组化检测

目的 观察正常大脑组织和星形细胞瘤组织（I－Ⅳ）中Ki-67、VEGF、bcl-2,cyclin-D1与p16的表达，探讨其辅助诊断的意义。方法 应用免疫组化检测13例正常脑组织和58例星形细胞瘤组织中Ki-67,VEGF,bcl-2,cyclin-D1和p16的表达。结果经χ^2检验和单因素方差分析。结果 Ki-67和VEGF在正常大脑组织中均不表达，而在所有级别的星形细胞瘤中均表达，差异极显著（P＜0．01。随着星形细胞瘤恶性程度的增高，Ki-67的表达增强，VEGF表达阳性的病例增加；肿瘤组织中微血管的形态亦出现相应的变化，每两组间的差异极显著（P＜0．01）。bcl-2在4个实验组中均表达，各组间表达差异显著（P＜0．01），且随着肿瘤恶性程度的增高表达增强。cyclin-D1的表达阳性率各组间差异不显著（P＞0．05）。正常脑组织中p16有一定的表达，阳性率69．2％；在转化为肿瘤细胞后p16的阳性率反而升高。肿瘤组织中，总的趋势是随着肿瘤恶性程度的增高p16的表达降低。结论 临床病理诊断过程中，Ki-67,bcl-2的免疫组化检测可对星形细胞瘤的分级诊断提供非常有意义的依据。而VEGF的作用需结合微血管形态的变化一起考虑。cyclin-D1和p16的免疫组化检测不够敏感，故辅助诊断意义不大。

Expression of Ki-67, VEGF, bcl-2, cyclin-D1 and p16 in astrocytoma

Objective To observe the expression of Ki 67, VEGF, cyclin D1 and p16 in astrocytoma and to explore its role in the diagnosis. Methods Thirteen autopsy cases of normal brain and 58 cases of astrocytomas were used in this immunohistochemical study. The data were statistically tested with SPSS. Results All the normal brains did not expressed Ki 67 and VEGF. Bcl 2 was expressed in both the normal brain and astrocytoma. With increase of tumor grade, expression of Ki 67, VEGF and bcl 2 was enhanced in astrocytomas. The density of blood vessels was also increased with malignancy. There was no significant difference in cyclin D1 expression in all groups. The higher the grade of astrocytoma, the less the expression of p16. But the number of p16 positive cells in normal brain was lower than that in well differentiated astrocytoma. Conclusions Immunohistochemical detection of Ki 67 and bcl 2 plays an adjunct role in the differential diagnosis of astrocytoma. Significance of VEGF expression should be considered together with changes in blood vessel density. Cyclin D1 and p16 immunostaining is not sensitive enough to be used in the diagnosis of astrocytoma.