hTERC基因表达在宫颈病变诊治中的应用

目的：探讨宫颈脱落细胞中hTERC的基因表达在宫颈上皮内瘤样病变（CIN）诊断与治疗中的应用。方法：抽取行子宫颈癌筛查的724例妇女为研究对象，对其同步进行宫颈脱落细胞的液基细胞学检查、第二代杂交捕获技术（HC-Ⅱ）检测高危型HPV（HR-HPV）和荧光原位杂交（FISH）技术检测hTERC基因。对于细胞学为未明确诊断意义的不典型鳞状上皮细胞（ASCUS）及以上病变，和（或）HR-HPV阳性者均行阴道镜下宫颈四象限多点活检进行病理诊断。结果：724例中经病理确定为CINⅠ，Ⅱ，Ⅲ及子宫颈癌者分别为251例（34.67%）、17例（2.35%）、48例（6.63%）和10例（1.38%），宫颈脱落细胞hTERC的扩增率为11.05%。①724例HPV阳性率为39.64%；hTERC扩增在HPV阳性与阴性组分别为19.86%与5.26%（χ2=37.556，P ＜0.01）。②hTERC扩增在细胞学无宫颈上皮内瘤变（NILM）组为5.19%、ASCUS为10.23%、低度鳞状上皮内瘤样病变为（LSIL）11.84%、非典型鳞状上皮细胞－不除外高度鳞状上皮内瘤变（ASC-H）为21.43%、高度鳞状上皮内瘤样病变（HSIL）为73.17%、鳞状细胞癌（SCCA）为100.00%、非典型腺上皮细胞（AGC）为50.00%；hTERC在HSIL及以上病变中的扩增率明显高于LSIL及以下病变（χ2=186.755，P ＜0.01）。③在不同组织学结果中hTERC的扩增率分别为，NILM 3.70%、CINⅠ4.38%、CINⅡ47.06%、CINⅢ58.33%、浸润癌90.00%，hTERC在CINⅡ及以上级别病变中的扩增率明显高于CINⅠ和NILM者 （χ2=144.597，P ＜0.01）。结论：hTERC的扩增与宫颈细胞学和组织学异常密切相关，hTERC扩增与否有可能作为判断有无高度病变及估计预后的指标之一。

The Application of hTERC Gene Amplification in Diagnosis and Treatment of Cervical Lesions

Objective：To investigate the amplification of hTERC gene in the cervical exfoliated cells，explore its value in diagnosis and treatment of cervical intraepithelial neoplasia（CIN）. Methods：724 women were examined with liquid-based cytology, high-risk human papillomavirus（HR-HPV） testing using hybrid capture Ⅱ（HC-Ⅱ） and hTERC gene detection using fluorescence in situ hybridization（FISH） in Peking University Shenzhen Hospital. The patients with ASCUS and above lesion and/or positive HR-HPV results were examined by colposcopy，multiple biopsies of cervical quadrant and pathology. Results：The frequency of CIN Ⅰ,Ⅱ,Ⅲ，cervical cancer were 251（34.67%），17（2.35%），48（6.63%）and 10（1.38%） respectively in 724 patients， the rates of hTERC gene amplification was 11.05%. There was significant difference of hTERC amplification among the samples with different cytological and histological lesions and the HPV infection（P <0.01）. ①The positive rate of HPV infection in 724 patients was 39.64%；The positive rates of hTERC gene amplification were 19.86% in HPV positive and 5.26% in HPV negative （χ2=37.556，P ＜0.01）. ②In cytology，the rates of hTERC gene amplification were NILM（5.19%），ASCUS （10.23%），LSIL（11.84%），ASC-H（21.43%），HSIL （73.17%）， SCCA （100.00%），AGC（50.00%）；There was a marked increase of hTERC amplification in patients with HSIL and above lesion （χ2=186.755，P ＜0.01）. ③In histology，the rates of hTERC gene amplification were respectively normal（3.70%），CINⅠ（4.38%），CINⅡ（47.06%），CINⅢ（58.33%），invasive carcinoma（90.00%）. There was a marked increase of hTERC amplification in patients with CINⅡand above lesion（χ2=144.597，P ＜0.01）. Conclusion：There was a tight correlation between amplification of hTERC and the histological and cytological lesion. hTERC amplified or not may be as a prognostic indicator to judge whether high grade lesion or not.