瘦素在宫颈病变中的表达和意义

doi:10.3877/cma.j.issn.1673-5250.2012.04.018

目的

探讨瘦素在宫颈病变组织中的表达与临床病理学参数的关系。

方法

选择2003年9月至2004年12月于同济医院确诊并接受治疗的142例宫颈病变患者为研究对象，并按照组织病理学结果将其分别纳入宫颈炎组(n＝12)、宫颈上皮内瘤变(CIN)Ⅰ组(n＝23)、CINⅡ组(n＝25)、CINⅢ组(n＝21)及宫颈癌组(n＝58)，分别测定各组瘦素表达强度及利用CD₃₄标记宫颈组织中血管内皮细胞，并计算微血管密度(MVD)(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试对象本人的知情同意，并与之签署临床研究知情同意书)。

结果

瘦素在宫颈炎组、CIN各组及宫颈癌组的阳性表达率逐渐增加，且其余4组分别与宫颈炎组比较，差异均有统计学意义(P<0.05)。宫颈癌组瘦素和CD₃₄表达与宫颈癌分化程度、淋巴结转移呈正相关关系(P<0.05)，而与患者年龄、临床分期无明显相关性(P>0.05)。宫颈癌组中MVD值随瘦素和CD₃₄表达强度增强逐渐升高，且不同表达强度间比较，差异有统计学意义(P<0.05)。

结论

瘦素是宫颈癌重要的血管生长因子，瘦素的异常表达与肿瘤的发生发展密切相关。

关键词: 瘦素, CD₃₄, 微血管密度, 宫颈癌, 宫颈上皮内瘤变

Objective

To evaluate the expression and clinical significance of leptin in cervical leison.

Methods

A totol of 142 women with cervical lesion were recruited in Tongji Hospital from September 2003 to December 2004.They were divided into chronic cervicitis group(n=12), cervical intraepithelial neoplasia(CIN)Ⅰgroup(n=23), CINⅡgroup(n=25), CINⅢgroup(n=21)and cervical cancer group(n=58) according to the histopathological results.Microvessels were immunohistochemical lablled with an antibody to CD₃₄. Microscope analysis was used to evaluate microvessel density (MVD). The study protocal was approved by the Ethical Review Board of Investigation in Human Being of Xiangan Hospital. Informed consent was obtained from each patients.

Results

The expression of leptin was significantly higher in CIN and cervical cancer groups than that in chronic cervicitis group(P<0.05). In addition, in cervical cancer group, there was no significant difference for leptin and CD₃₄ expression in different age and clinical stages(P>0.05), however, they were positively correlation with the degree of malignance and distant metastasis(P<0.05).

Conclusions

Leptin is an important vascular endothelial growth factor(VEGF) in cervical cancer and local overexpression of leptin in cervical cancer may contribute to tumor progression by increasing angiogenesis and tumor growth.

Key words: leptin, CD₃₄, microvessel density, cervical cancer, cervical intraepithelial neoplasia

表1 4组瘦素和CD₃₄表达情况比较[n(%)]

Table1 Comparison of expression of leptin and CD₃₄ among four groups[n(%)]

组别	n	瘦素表达					MVD值(/HP，±s)
组别	n	－	＋	＋＋	＋＋＋	阳性表达率	MVD值(/HP，±s)
宫颈炎组	15	11	4	0	0	4(26.7)	14.93±6.95
CINⅠ组	23	12	7	3	1	11(47.8)	16.12±7.35
CINⅡ组	25	10	9	3	3	15(60.0)	17.25±1.27
CINⅢ组	21	4	6	7	4	17(81.0)	19.38±6.74
宫颈癌组	58	2	10	21	25	56(96.6)	22.51±3.09

表1 4组瘦素和CD₃₄表达情况比较[n(%)]

Table1 Comparison of expression of leptin and CD₃₄ among four groups[n(%)]

组别	n	瘦素表达					MVD值(/HP，±s)
组别	n	－	＋	＋＋	＋＋＋	阳性表达率	MVD值(/HP，±s)
宫颈炎组	15	11	4	0	0	4(26.7)	14.93±6.95
CINⅠ组	23	12	7	3	1	11(47.8)	16.12±7.35
CINⅡ组	25	10	9	3	3	15(60.0)	17.25±1.27
CINⅢ组	21	4	6	7	4	17(81.0)	19.38±6.74
宫颈癌组	58	2	10	21	25	56(96.6)	22.51±3.09

图1 瘦素在宫颈炎组中的表达(×200，SP)

Figure 1 Leptin expression in cervicitis group(×200，SP)

图2 瘦素在CINⅠ组中的表达(×200，SP)

Figure 2 Leptin expression in CINⅠgroup(×200，SP)

图3 瘦素在CINⅡ组中的表达(×200，SP)

Figure 3 Leptin expression in CINⅡgroup(×200，SP)

图4 瘦素在CINⅢ组中的表达(×200，SP)

Figure 4 Leptin expression in CINⅢ group(×200，SP)

图5 瘦素在宫颈癌组中的表达(×200，SP)

Figure 5 Leptin expression in cervical cancer group(×200，SP)

图6 CD₃₄在宫颈癌组中的表达(×200，SP)

Figure 6 CD₃₄ expression in cervical cancer group(×200，SP)

表2 瘦素和CD₃₄表达的多因素logistic回归分析

Table 2 Multiple－factor logistic regression analysis of expression of leptin and CD₃₄

自变量	r	s	Wald值	P	OR	95%CI
自变量	r	s	Wald值	P	OR	Lower	Upper
年龄	0.263	0.633	0.570	0.676	1.153	0.374	4.527
分化程度	1.612	0.552	8.125	0.008	5.056	1.716	15.088
临床分期	0.606	0.471	1.103	0.058	1.735	0.749	4.621
淋巴结转移	3.849	0.714	18.742	0.001	14.352	5.307	28.292

表2 瘦素和CD₃₄表达的多因素logistic回归分析

Table 2 Multiple－factor logistic regression analysis of expression of leptin and CD₃₄

自变量	r	s	Wald值	P	OR	95%CI
自变量	r	s	Wald值	P	OR	Lower	Upper
年龄	0.263	0.633	0.570	0.676	1.153	0.374	4.527
分化程度	1.612	0.552	8.125	0.008	5.056	1.716	15.088
临床分期	0.606	0.471	1.103	0.058	1.735	0.749	4.621
淋巴结转移	3.849	0.714	18.742	0.001	14.352	5.307	28.292

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Expression and Clinical Significance of Leptin in Cervical Leison

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Expression and Clinical Significance of Leptin in Cervical Leison