MUC5AC、CDX －2、Ki67在胆囊黏膜肠上皮化生及胆囊腺癌中的表达及其意义

摘要

目的：观察 MUC5AC、CDX －2、Ki67在胆囊黏膜肠上皮化生及胆囊腺癌中的表达，探讨胆囊黏膜肠上皮化生与胆囊腺癌的关系。方法：收集胆囊黏膜肠上皮化生40例、胆囊腺癌40例，25例胆结石胆囊正常黏膜做对照。采用免疫组化方法检测 MUC5AC、CDX －2、Ki67三种蛋白质在胆结石胆囊正常黏膜、胆囊黏膜肠上皮化生和胆囊腺癌中的表达。结果：MUC5AC 在胆结石胆囊正常黏膜、胆囊黏膜肠上皮化生、胆囊腺癌中的表达率分别为12．00％（3／25）、62．50％（25／40）、20．00％（8／40）。CDX －2在胆结石胆囊正常黏膜、胆囊黏膜肠上皮化生、胆囊腺癌中的表达率分别为0．00％（0／25）、75．00％（30／40）、50．00％（20／40）。Ki67在胆结石胆囊正常黏膜、胆囊黏膜肠上皮化生、胆囊腺癌中的增殖指数分别为0％～2％、3％～15％、25％～95％。三组间比较 MUC5AC 在胆囊黏膜肠上皮化生的阳性表达率明显高于其他两组，差异有统计学意义（P＝0．001）。CDX －2在胆囊黏膜肠上皮化生、胆囊腺癌中的阳性表达率明显高于胆结石胆囊正常黏膜，差异有统计学意义（P ＝0．001）。Ki67在三组间阳性表达率依次升高。结论：胆囊黏膜肠上皮化生可能是胆囊腺癌发生过程中的一个重要阶段，MUC5AC、CDX －2可能参与了这一过程。结合 Ki67标记核增殖指数，可协同判断胆囊黏膜异型增生，为胆囊黏膜异型增生及胆囊腺癌的病理诊断及鉴别诊断提供检测依据。%Objective:To investigate the relationship between the expression of MUC5AC,CDX -2,Ki67 in gall-bladder mucosa intestinal metaplasia and gallbladder adenocarcinoma.Methods:Forty gallbladder mucosa intestinal metaplasia cases,gallbladder adenocarcinoma 40 cases,gallbladder normal mucosa 25 cases were tested for the ex-pression of MUC5 AC,CDX -2 ,Ki67 by immunohistochemical method.Results:MUC5 AC expression rates were 12.00%(3 /25),62.50%(25 /40),20.00%(8 /40)in gallbladder normal mucosa,intestinal metaplasia and gall-bladder adenocarcinoma respectively.CDX -2 expression rates were 0.00%(0 /25),75.00(30 /40),50.00%(20 /40)in the three groups respectively.Ki67 proliferation index were 0% ~2%,3% ~5%,25% ~95% in the three groups respectively.MUC5AC positive expression rate in intestinal metaplasia was obviously higher than that of other two groups,and the difference was statistically significant (P =0.001).CDX -2 positive expression rate in intestinal metaplasia and the gallbladder adenocarcinoma was obviously higher than the gallbladder normal mucosa,and the difference was statistically significant(P =0.001 ).Ki67 positive expression rate was increased in turn among the three groups.Conclusion:The gallbladder mucosa intestinal metaplasia may be an important stage in the process of gallbladder adenocarcinoma,and MUC5AC,CDX -2 may be involved in this process,which are useful for diagnosis and differential diagnosis of the gallbladder mucosal hyperplasia and gallbladder adenocarcinoma combined with Ki67.