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目的研究p21蛋白和K-ras蛋白在先天性胆管扩张症(CBD)中的表达及其相互关系,并探讨其在CBD癌变发生发展过程中的临床意义。方法收集本科2000年1月-2007年9月确诊为CBD的36例患儿行胆总管囊肿切除术的组织标本,9例正常对照组胆管组织来自本院病理学系流产胎儿及死于非胆管系统疾病儿童尸检标本。标本组织经40g·L-1甲醛固定,石蜡包埋,切片固定处理,应用免疫组织化学技术对标本中p21蛋白和K-ras蛋白表达进行检测。应用SPSS13.0软件进行统计学处理。结果36例CBD标本中,5例K-ras蛋白表达阳性,阳性率为13.8%,正常对照组胆管未检出阳性;CBD中p21蛋白的阳性率为55.6%,显著低于正常对照组(100%)(P<0.05)。结论p21蛋白和K-ras蛋白表达异常可能是CBD癌变发生过程中的一个早期信号。K-ras蛋白在正常胆管组织中不表达,而在CBD中高表达,表明CBD癌变的发生在蛋白表达水平上已具有恶性增殖信号。故早期手术切除囊肿组织是防止CBD发生癌变的主要手段,术后根据p21蛋白和K-ras蛋白的表达情况早期干预可能有助于阻止或减少癌变。
Objective To study the expression of p21 protein and K-ras protein in congenital bile duct dilatation (CBD) and to explore its clinical significance in the development of CBD carcinogenesis. Methods Thirty-six cases of choledochal cyst resected from January 2000 to September 2007 in our hospital were collected. Tissue samples from 9 normal controls were collected from the abortion fetuses and died of non-biliary obstruction Systemic disease autopsy specimens of children. Specimens were fixed with 40g · L-1 formalin, embedded in paraffin and fixed in slices. Immunohistochemistry was used to detect the expression of p21 protein and K-ras protein. Application SPSS13.0 software for statistical analysis. Results The positive expression rate of K-ras protein was 13.8% in 5 out of 36 CBD specimens, but not in the normal control group. The positive rate of p21 protein in CBD was 55.6%, which was significantly lower than that of the normal control group %) (P <0.05). Conclusion The abnormal expression of p21 protein and K-ras protein may be an early signal in carcinogenesis of CBD. K-ras protein is not expressed in the normal bile duct tissue, but high expression in the CBD, indicating that carcinogenesis of the CBD has a malignant proliferation signal at the protein expression level. Therefore, early surgical removal of cysts is to prevent the occurrence of CBD cancer is the main means of postoperative expression of p21 protein and K-ras protein early intervention may help to prevent or reduce cancer.