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目的 :探讨c -Ha -ras基因突变及 p21蛋白表达与妊娠滋养细胞疾病 (GTD)发生发展的关系 ,寻找具有特异性的可预测PTD的诊断标记。方法 :采用PCR -SSCP法及SP免疫组化法 ,对90例GTD组织中c -Ha -ras基因第1外显子点突变及其产物 p21表达进行检测 ,以正常足月新鲜胎盘30例为对照。结果 :所有正常胎盘组织ras突变及p21表达均为阴性。ras基因突变在恶性GTD中为36 7 % ,CM将来发展成为PTD的为43 3 % ,均高于CM无PTD发展的16 7 %。恶性GTD,Ⅰ、Ⅱ、Ⅲ级组织分化者点突变率分别为15 4 %、40 %、71 4 % ,各级间差异有显著性 (P<0 01)。不同转归的CM,p21表达不同 ,CM中发展成为PTD者 ,p21表达率为83 3 % ,明显高于未发展成PTD者的43 3 %(P<0 005) ,亦高于恶性GTD的60%(P<0 05)。结论 :GTD的发展演进与ras基因突变及p21表达有关 ,ras突变及p21表达可考虑作为预测PTD的诊断指标之一。GTD由良性到恶性的发展过程中 ,p21表达量存在由低→高→低的内在变化 ,其原因和机理尚需深入探讨
Objective: To investigate the relationship between the mutation of c-Ha-ras gene and the expression of p21 protein and the occurrence and development of gestational trophoblastic disease (GTD), so as to find out the diagnostic markers of PTD with specificity. Methods: PCR-SP method and SP immunohistochemistry were used to detect the point mutation of c-Ha-ras gene exon 1 and the expression of p21 gene in 90 GTD cases. Totally 30 normal-term fresh placenta Control. Results: All the normal placenta ras mutation and p21 expression were negative. The ras gene mutation was 36.7% in malignant GTD and 43.3% in CM, which was higher than that of CM without PTD. In malignant GTD, the point mutation rates of grade Ⅰ, Ⅱ and Ⅲ were 15 4%, 40% and 71 4%, respectively, with significant differences (P <0.01). Different prognosis of CM, p21 expression of different, CM to develop into a PTD, p21 expression was 83 3%, significantly higher than those who did not develop PTD 43 3% (P <0 005), also higher than the malignant GTD 60% (P <0 05). CONCLUSION: The development of GTD is related to ras gene mutation and p21 expression. The ras mutation and p21 expression may be considered as one of the diagnostic criteria for predicting PTD. In the development of benign and malignant GTD, the expression level of p21 varies from low to high and low, the reason and mechanism need to be further explored