不同部位胆脂瘤侵袭性的免疫组化比较

目的用免疫组化的方法探讨不同原发部位胆脂瘤侵袭性的差异。方法根据胆脂瘤的原发部位对标本进行分组，其中上鼓室胆脂瘤7份，鼓室窦胆脂瘤8份，外耳道胆脂瘤4份。对中耳胆脂瘤根据上皮下基质炎症情况分别进行观察，其中炎症组7份，非炎症组8份。用免疫组化SP法观察增殖细胞核抗原Ki-67和Ⅳ型胶原在不同原发部位，基质不同炎症反应程度的胆脂瘤标本中的表达，并对染色结果进行量化处理，采用非参数秩和检验并进行统计学对比分析。结果Ki-67在胆脂瘤中具有明显的表达，计算表达阳性率，比较上鼓室胆脂瘤和鼓室窦胆脂瘤的阳性率，差异没有统计学意义（Z=0．189，差异参数为0．850）。中耳胆脂瘤和外耳道胆脂瘤标本之间，差异也没有统计学意义（Z=1．306，差异参数为0．192）。对同一标本的不同部位按炎症反应程度进行量化分类比较，2组之间进行非参数的秩和检验，差异具有统计学意义（Z=2．939，差异参数为0．003）。Ⅳ型胶原在胆脂瘤上皮中仅有间断表达，尤其在胆脂瘤乳头状突出的部位表达断裂明显。结论原发部位的不同不是造成胆脂瘤侵袭性差异的主要因素，而炎症的严重程度能影响胆脂瘤的侵袭性。Ⅳ型胶原在各组胆脂瘤的表达中的断裂说明胆脂瘤侵袭骨质的行为是胆脂瘤局部的至少是从局部开始并逐渐扩散的行为，局部病情的严重程度与局部的炎症反应程度密切相关。

Immunohistochemical discrimination of aggressivity between the cholesteatoma from different positions

Objective To investigate whether the cholesteatoma from different positions have different biological characteristics. Methods The expression of the Ki-67 and collagen IV in 19 specimens of cholesteatoma were stained immunohistochemically using the SP method, according to the origin of the specimens, include 7 cases from the epitympanum, 8 cases from tympanic sinus and 4 cases from the out acoustic canal. According to the severity of the inflammation in the perimatrix, the inflammation group included 7 cases, the non-inflammation group included 8 cases. Results The average count was the same between the cholesteatoma from epitympanum and tympanic sinus. And the count of the cholesteatoma in the middle ear was also the same to the cholesteatoma from the out acoustic canal. But even from the same sample, the cholesteatoma from the positions with severe inflammation in the perimatrix count much higher, and the difference was statistically significant. Collagen IV had been found to localized in the basic membrane. In some specimens the staining of the collagen IV was not continuous. Conclusions The results suggested that it was the severity of inflammation in the perimatrix influenced the differences, but not the origins of the cholesteatoma.