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目的：探讨角化棘皮瘤（ＫＡ）与皮肤高分化鳞癌（ｗＳＣＣ）在细胞凋亡方面的差异。方法：用脱氧核苷酰转移酶（ＴｄＴ）介导的ｄ－ＵＴＰ生物素缺口末端标记技术（ＴＵＮＥＬ），原位检测了ＫＡ和ｗＳＣＣ的凋亡细胞。用免疫组化技术研究了皮损部位与细胞凋亡有关ｂａｘ和ｂｃｌ－２基因产物的表达。结果：凋亡细胞在ＫＡ发生率为８０％（１６／２０）；在ｗＳＣＣ也为８０％（８／１０）。两者相比无显著性差异（ｘ~２＝１．２５０ ｐ＝０，２１１）。两组均仅有少数与正常皮肤相邻的瘤细胞有微弱ｂｃｌ－２表达。全部患者表达ｂａｘ蛋白，强度为１＋～３＋不等。两组ｂｃｌ－２、ｂａｘ表达无显著性差异（ｘ_(ｂｃｌ－２) ~２＝１．２５０ ｐ＝０．２１１；Ｘ_(ｂａｘ)~２＝０．９０９，ｐ＝０，３６３）。凋亡率ｂｃｌ－２表达负相关，与ｂａｘ表达显著正相关。结论：ＫＡ和ｗＳＣＣ凋亡的形态学和基因调控相似。细胞凋亡不宜作为ＫＡ和ｗＳＣＣ鉴别诊断指标。
Objective: To investigate the difference of apoptosis between keratoacanthoma (KA) and squamous cell carcinoma of the skin (wSCC). METHODS: Apoptotic cells of KA and wSCC were detected in situ using DNA deoxynucleotidyl transferase (TdT) mediated d-UTP biotin nick end labeling (TUNEL). Immunohistochemical technique was used to study the expression of bax and bcl-2 gene products in the skin lesions and apoptosis. Results: The incidence of apoptotic cells in KA was 80% (16/20) and in wSCC was also 80% (8/10). There was no significant difference between the two (x~2=1.250 p=0,211). In both groups, only a few tumor cells adjacent to normal skin had weak bcl-2 expression. All patients expressed bax protein with intensity ranging from 1+ to 3+. There was no significant difference in the expression of bcl-2 and bax between the two groups (x_(bcl-2)~2=1.250 p=0.211; X_(bax)~2=0.909, p=0,363). Apoptotic rate bcl-2 expression was negatively correlated with bax expression and was significantly positively correlated. Conclusion: The morphology and gene regulation of KA and wSCC apoptosis are similar. Apoptosis should not be used as a differential diagnostic indicator for KA and wSCC.