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首页> 中文期刊> 《中国医学装备》 >IMP3在高龄葡萄胎及侵蚀性葡萄胎孕妇中的表达研究

IMP3在高龄葡萄胎及侵蚀性葡萄胎孕妇中的表达研究

         
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Objective:To investigate the expression of insulin-like growth factorⅡmRNA-binding protein 3(IMP3) in senile gravida (all of them were older than 40 years) with hydatidiform mole (HM) and invasive hydatidiform mole(IHM). Methods: 103 specimens of paraffin-embedded tissue of senile gravidas with HM who underwent complete curettage of uterine cavity and 88 specimens of paraffin-embedded tissue of senile gravida with IHM who underwent chemotherapy combined with hysterectomy were enrolled in the retrospective study. As the difference of serumβ-human chorionic gonadotropin (β-hCG), the HM specimens were divided into observation I group (β-hCG>2×105 IU/mL, 67 cases) and control I group (β-hCG<2×105 IU/mL, 36 cases), and the IHM specimens were divided into observation II group (β-hCG>2×105 IU/mL, 52 cases) and control II group (β-hCG<2×105 IU/mL, 36 cases). The streptavidin-peroxidase (SP) method of immunohistochemistry was applied to detect the expression of IMP3 in tissues of two groups, and its effects on deteriorated progress of HM and on diagnosis and treatment of IHM were analyzed. And the clinical values of its evaluation and its prognosis score also were researched and analyzed.Results: In observation I group, positive expression rate of IMP3 was 35.82％(24/67) and the canceration rate of IHM was 66.67％, and the canceration rate of IHM in patients with negative expression of IMP3 was 18.60％, and the difference of canceration rate between patients with positive expression of IMP3 and patients with negative expression of IMP3 was significant (x2=15.477,P<0.05). In control I group, positive expression rate of IMP3 was 8.33％, and the canceration rate in patients with positive expression of IMP3 was 100％, and it was 21.21％ in patients with negative expression of IMP3, and the difference of canceration rate between patients with positive expression of IMP3 and patients with negative expression of IMP3 was significant (x2=1.61,P<0.05). And the difference of positive expression of IMP3 between observation I group and control I group was significant (x2=9.148,P<0.05). In the observation II group, the positive expression rate of IMP3 was 94.23％ before chemotherapy, and it was 82.69％ after chemotherapy. In the control II group, the positive expression rate of IMP3 was 78.73％(28/36) before chemotherapy, and it was 58.33％(21/36) after chemotherapy. And the difference of positive expression of IMP3 between pre-and post chemotherapy in observation II group and control II group was significant (x2=3.868,x2=6.364,P<0.05), respectively. Conclusion: When serumβ-hCG of senile gravida was higher than 2×105 mIU/mL, the positive expression rate of IMP3 in these gravida was higher. Therefore,β-hCG was a high risk factor that was relative with the local metastasis and / or distant metastasis of HM. And the canceration rate of patients with positive expression rate of IMP3 was higher, therefore, the canceration degree of HM can be judged through detected the expression of IMP3 in patients with HM, and IMP3 can be used as molecular biomarker to detect local metastasis and / or distant metastasis of HM. Besides, in patients with IHM, the positive expression rate of IMP3 in post-chemotherapy was lower than that in pre-chemotherapy, while the declines of positive expression rate of IMP3 between serumβ-hCG was higher than 2×105IU/mL and it was lower than 2×105 IU/mL was not obvious, therefore, these patients should be continuously provided the appropriate treatment and follow-up.%目的:探讨胰岛素样生长因子ⅡmRNA结合蛋白3(IMP3)在40岁以上高龄葡萄胎(HM)及侵蚀性葡萄胎(IHM)孕妇中的表达.方法:回顾性选取103例40岁以上HM患者清宫术后石蜡包埋组织标本和88例IHM经化疗行子宫切除术石蜡包埋组织标本,按照患者组织标本中血清β-人绒毛膜促性腺激素(β-hCG)水平的不同,将HM标本分为观察组(β-hCG>2×105 mIU/ml,67例)和对照组(β-hCG<2×105 mIU/ml,36例);将IHM标本分为观察2组(β-hCG>2×105 mIU/ml,52例)和对照2组(β-hCG<2×105 mIU/ml,36例).应用免疫组织化学链霉亲和素-过氧化物酶(SP)法检测IMP3在两组组织中的表达,分析其在HM的恶化进展及IHM的病情诊疗效果,评估其预后评分的临床意义.结果:观察组IMP3的阳性表达率为35.82％(24/67),IHM的恶变率为66.67％;IMP3阴性表达者恶变为IHM的恶变率为18.60％,IMP3的阳性表达与IMP3阴性表达的恶变率比较,其差异有统计学意义(x2=15.477,P<0.05).对照组IMP3的阳性表达率为8.33％;IMP3阳性表达者恶变为IHM的恶变率为100％,IMP3阴性表达者恶变为IHM的恶变率为21.21％;IMP3的阳性表达与IMP3阴性表达的恶变率比较差异有统计学意义(x2=1.61,P<0.05).两组IMP3阳性表达率比较差异有统计学意义(x2=9.148,P<0.05).化疗前观察2组IMP3的阳性表达率为94.23％,化疗后阳性表达率为82.69％.对照2组化疗前IMP3的阳性表达率为77.78％(28/36),化疗后IMP3的阳性表达率为58.33％(21/36),两组化疗前和化疗后IMP3的阳性表达率比较差异具有统计学意义(x2=3.868,x2=6.364;P<0.05).结论:在高龄孕妇中血清β-hCG水平>2×105 mIU/ml的IMP3阳性率较高,是HM发生局部转移和(或)远处转移有关的高危因素,且IMP3表达阳性者发展为IHM率高,可通过检测IMP3在HM的表达判断HM恶化程度,可将IMP3作为检测HM发生局部转移和(或)远处转移的分子标志物.在IHM中,化疗后IMP3阳性率较化疗前均有下降,但患者血清β-hCG水平>2×105 mIU/ml与β-hCG<2×105 mIU/ml相比下降不明显,应继续给予相应治疗和随访观察.

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