Objective To analyze the differential expression and clinical significance of mucin 4 ( MUC4) in pancreatic in-traepithelial neoplasias (PanINs) and pancreatic ductal adenocarcinoma (PDAC). Methods We collected 85 cases of paraffin of pancreatic tissue specimens from Affiliated Changzheng Hospital of the Second Military Medical University from 2009-03-01 to 2011-12-31. Immunohistochemical SP method was used to examine the expression of MUC4 in 48 normal pancreatic duct (NP) tissues, 17 Pan-INs tissues and 20 PDAC tissues. The correlation of MUC4 expression with clinicopathological characteristics and prognosis of PDAC patients was analyzed. Results MUC4 was not expressed in NP;MUC4 expression gradually increased with the progression of pancre-atic tissue. The positive expression rates of MUC4 in NP, PanIN-1, PanIN-2, PanIN-3 and PDAC were 0, 17. 4%, 52. 6%, 84. 6%and 90. 0%, respectively; The immunohistochemical scores of MUC4 expression in NP, PanIN-1, PanIN-2, PanIN-3 and PDAC groups were 0, 1. 30±0. 89, 2. 58±1. 76, 4. 54±1. 64 and 7. 68±2. 34, with statistic significance among groups (P<0. 001). The ex-pression level of MUC4 was associated with neural invasion ( P=0. 028) , lymph node metastasis ( P=0. 020) and CA19-9 level ( P=0. 028) in PDAC. The median overall survival(OS) of PDAC patients was 17. 0 months(95%CI:14. 809-19. 191 months);The median OS of MUC4 high expression group ( immunohistochemical score≥8. 8) and low expression group ( immunohistochemical score <8. 8) were 13. 0 months ( 95%CI:7. 456-18. 544 months) and 20. 0 months ( 95%CI:15. 521-24. 479 months) , with statistic significance ( P=0. 003) . Conclusion MUC4 perhaps participates in the PDAC occurrence and development. MUC4 expression may be an early event in the evolution of PDAC. MUC4 high expression probably affects both invasion and metastasis of PDAC, and probably predicts poor prognosis.%目的：探讨黏蛋白4（ MUC4）在胰腺上皮内瘤变（ PanINs）和胰腺导管腺癌（ PDAC）中的表达及临床意义。方法收集2009年3月1日至2011年12月31日第二军医大学附属长征医院的胰腺组织蜡块标本共85例。采用免疫组化SP法检测MUC4在48例正常胰腺导管（NP）、17例PanINs及20例PDAC组织中的表达情况。分析MUC4的表达与PDAC临床病理特征及预后的关系。结果 MUC4在NP组织中不表达；随着胰腺组织异型程度的增加，MUC4的表达逐渐增强；MUC4在NP、PanIN-1、PanIN-2、PanIN-3及PDAC组织中的阳性表达率分别为0、17．4％、52．6％、84．6％和90．0％；免疫组化评分分别为0、1．30±0．89、2．58±1．76、4．54±1．64和7．68±2．34，组间比较差异有统计学意义（ P＜0．001）。 MUC4在PDAC组织中的表达与神经浸润（ P＝0．028）、淋巴结转移（ P＝0．020）和CA19-9（ P＝0．028）有关。20例PDAC患者的中位总生存时间为17．0个月（95％CI：14．809～19．191个月）；MUC4高表达者（免疫组化评分≥8．8分）为13．0个月（95％CI：7．456～18．544个月）， MUC4低表达者（免疫组化评分＜8．8分）为20．0个月（95％CI：15．521～24．479个月），差异有统计学意义（ P＝0．003）。结论MUC4可能参与了PDAC的发生、发展，其表达升高可能是PDAC演进的早期事件，MUC4高表达可能对PDAC的浸润和转移均有影响并提示预后不良。
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