摘要：
目的 观察p57、CD34、Ki-67在完全性葡萄胎(CHM)、部分性葡萄胎(PHM)和水肿性流产胎(HA)组织中的表达,探讨其在胎盘绒毛病变诊断及鉴别诊断中的作用.方法 收集2003年1月至2013年12月安丘市人民医院保存的CHM组织45例、PHM组织40例、HA组织28例及正常妊娠胎盘组织22例,采用免疫组织化学法检测胎盘绒毛组织中p57、CD34、Ki-67的表达.结果 CHM、PHM、HA及正常妊娠组织中p57阳性表达率分别为2.22％ (3/45)、85.00％ (34/40)、89.29％(25/28)、95.45％ (21/22),CHM组织中p57阳性表达率显著低于PHM、HA及正常妊娠组织(x2=59.908、57.055、58.238,P＜0.01),PHM、HA及正常妊娠组织中p57阳性表达率比较差异均无统计学意义(x2=0.022、0.681、0.074,P＞0.05).CD34在CHM、PHM、HA及正常妊娠组织中的表达分别为10.27 ±3.00、11.13 ±2.58、35.57±2.36、35.55±2.22,CHM、PHM组织中CD34表达显著低于HA及正常妊娠组织(t=37.89、37.86、39.79、37.40,P＜0.01),HA与正常妊娠组织中CD34表达比较差异无统计学意义(t=1.485,P＞0.05),CHM与PHM组织中CD34表达比较差异无统计学意义(t=1.404,P＞0.05).Ki-67在CHM、PHM、HA及正常妊娠组织中的阳性表达率分别为64.44％ (29/45)、55.00％ (22/40)、14.29％ (4/28)、9.09％(2/22),CHM、PHM组织中Ki-67阳性表达率显著高于HA及正常妊娠组织(x2=18.21、12.61、17.53、11.56,P＜0.01),HA与正常妊娠组织中Ki-67阳性表达率比较差异无统计学意义(x2=0.015,P＞0.05),CHM与PHM组织中Ki-67阳性表达率比较差异无统计学意义(x2=0.787,P＞0.05).结论 p57有助于鉴别CHM与其他胎盘绒毛水肿性病变,CD34和Ki-67有助于鉴别葡萄胎和HA;p57、CD34和Ki-67联合检测有助于CHM、PHM及HA的鉴别诊断.%Objective To observe the expression of p57,CD34 and Ki-67 in complete hydatidiform mole (CHM),partial hydatidiform mole (PHM) and hydropic abortus (HA),so as to investigate the role of the expression in the diagnosis and differential diagnosis of edematous lesions of placental villi.Methods A total of 45 cases of CHM tissue,40 cases of PHM tissue,28 cases of HA tissue and 22 cases of normal pregnancy tissue were collected from January 2003 to December 2013 in Anqiu People's Hospital.The expression of p57,CD34 and Ki-67 in placental villi were detected by immunohistochemistry.Results The positive expression rate of p57 in CHM,PHM,HA and normal pregnancy tissues was 2.22％ (3/45),85.00％ (34/40),89.29％ (25/28) and 95.45 ％ (21/22),respectively;the positive expression rate of p57 in CHM tissues was significantly lower than that in PHM,HA and normal pregnancy tissues (x2 =59.908,57.055,58.238;P ＜ 0.01);there was no significant difference in the positive expression rate of p57 in PHM,HA and normal pregnancy tissues (x2 =0.022,0.681,0.074;P ＞0.05).The expression of CD34 in CHM,PHM,HA and normal pregnancy tissues was 10.27 ± 3.00,11.13 ±2.58,35.57 ± 2.36 and 35.55 ± 2.22 respectively;the expression of CD34 in CHM and PHM tissues was significantly lower than that in HA and normal pregnancy tissues (t =37.89,37.86,39.79,37.40;P ＜ 0.01).There was no significant difference in the expression of CD34 between HA and normal pregnancy tissues (t =1.485,P ＞ 0.05),and there was no significant difference in the expression of CD34 between CHM and PHM tissues (t =1.404,P ＞ 0.05).The positive expression rate of Ki-67 in CHM,PHM,HA and normal pregnancy tissues was 64.44％ (29/45),55.00％ (22/40),14.29％ (4/28) and 9.09％ (2/22) respectively;the positive expression rate of Ki-67 in CHM and PHM tissues was significantly higher than that in HA and normal pregnancy tissues (x2 =18.21,12.61,17.53,11.56;P ＜ 0.01);there was no significant difference in the positive expression rate of Ki-67 between HA and normal pregnant tissues (x2 =0.015,P ＞ 0.05),and there was no significant difference in the positive expression rate of Ki-67 between CHM and PHM tissues (x2 =0.787,P ＞ 0.05).Conclusion p57 helps to identify CHM and other edematous lesions of placental villi,CD34 and Ki-67 help to identify hydatidiform mole and HA.Combined detection of p57,CD34 and Ki-67 is helpful for differential diagnosis of CHM,PHM and HA.
