| Objective:1. The purpose of this study was to detect the expression of human telomerase mRNA component gene (hTERC) and the human papillomavirus (HPV) genotypes in cervical exfoliated epithelial cells of cases with cervical intraepithelial neoplasia (CIN).To analyze the relationship among infection of HPV genotypes, amplification of hTERC and CIN.2. HPV genotypes detection and thinprep cytologic test (TCT) were compared to the hTERC detection.To study the value of the hTERC detection in diagnosis and prediction for CIN.3. We followed-up the cases with CIN who had been gived conservative treatment to analyze the value of the hTERC detection in following-up of CIN after treatment.Method:A series of 90 cases including 20 cases with chronic cervicitis for negative control group,36 cases with SCC for positive group,34 case of study group including 8 cases with CINâ… ,9 cases with CINâ…¡, and 17 cases with CINâ…¢,who were diagnosed by histopathological examination in the General Hospital of Jinan Military Area.The cases with CINâ… or CINâ…¡were subjected to Leep.8 cases with CINâ…¢were subjected to Leep and 9 cases with CINâ…¢were subjected to hysterectomy. The cases with positive margin after conservative treatment were subjected to Leep again, until the surgical margin was negative. Before treatment all of them were detected the expression of hTERC applying FISH, at the same time detected HPV genotypes applying flow-through hybridization and gene chip and TCT.All of the cases with CIN were followed up for 6 months after treatment except whom were subjected to hysterectomy.6 months after treatment, they were detected by FISH,HPV,and TCT. Biopsy under colposcopy was done when necessary.Results:1. Expression of hTERC in different pathological types:The percentage of cells with amplification of hTERC increased with the increasing of pathological grade (p<0.01). Both the positive rate of hTERC and intensity of hTERC also increased. The rate of negative and strongly positive expression of hTERC were significantly different between each groups (all p<0.01). The proportion with high-copy type of hTERC (2:4 type and 4:4 type) increased with the increasing of pathological grade (both p<0.05). The proportion of 2:3 type also increased (p<0.01). The proportion of 2:2 type declined with the increasing of pathological grade (p<0.01).2. The expression of hTERC in CIN before and after treatment:The percentage of cells with amplification of hTERC was obviously lower than prior treatment.There was a significant difference (p<0.01).The positive expression of hTERC was major in prior treatment group,while in post-treatment group the negative expression was major,and there was a significant difference (p<0.01). The rate of strongly positive expression decreased after treatment (p<0.01). The types followed by 2:3,2:4,4:4,2:2 types were major in prior treatment group,and the types followed by 2:2,2:3 types were major in post-treatment group.The proportion of 2:2 type was significantly higher than that in prior treatment group, and there was a significant difference (p<0.01). The proportion of 2:4 type was lower than that in prior treatment group, and there was significant difference (p<0.05).3. HPV infection in different pathological types and in post-treatment group: HPV16 is the major HPV genotype in CINâ…¡group, CINâ…¢group, and SCC group. HPV-negative and other HPV genotype were major in CIN I group.HPV-negative was major in chronic cervicitis group.With the increasing of pathological grade, both HPV-positive rate and HPV16 positive rate was obviously increased (both p<0.01). HPV-positive rate in CIN group decreased significantly after treatment (p<0.01).4. The results of hTERC compared with the HPV detection:Different HPV genotype resulted in different amplification of hTERC. The positive rates of hTERC in HPV16 group,other high-risk HPV genotype group and negative/low-risk HPV genotype group were as follow 90.38%,66.67%,28.13%, which were significantly different between each group(P<0.01). The positive rate of hTERC was highest in HPV16 group.5. The results of TCT compared with hTERC, the result of TCT in CIN after treatment:The expression of hTERC increased with the severity of the cytology classification (P<0.01). The positive rates of hTERC in normal group, SCC group, and ASCUS group were as follow 0.00%,97.12%,66.67%. The positive rates of TCT significantly decreased after treatment (P<0.01).6. Comparing among the 3 detections, the specificity (Namely, the ratio of the case who were determined to be negative by experiments and had really no disease), sensitivity (Namely, the ratio of the case who were determined to be positive by experiments and really had disease) and so on. The pecificity and sensitivity of hTERC detection were respectively 100.00%,85.71%. The hTERC detection was better than HPV and TCT detection, and it can make up for the disadvantage of TCT and HPV detection.Conclusion:1. The positive rate of hTERC and percentage of cells with amplification of hTERC increased with the severity of pathological grade.The positive intensity and the proportion with high-copy type of hTERC increased also with the severity of pathological grade.Tip: Maybe the abnormal amplification of hTERC is the early incident in the process of forming cervical cancer. In the process of forming cervical cancer hTERC plays an important role.And hTERC can be used as a molecular marker in screening for CIN. The amplification of hTERC positively correlates with CIN.The positive expression of hTERC prompt malignant potential of CIN. The amplification of hTERC can be used as an indicator of CIN for forecasting its progression.2. The specificity and sensitivity of hTERC detection applying FISH are higher than those of HPV detection and TCT detection.And the FISH technology is objective, repeatable, noninvasive, etc. It can be used as a detection method for CIN besides the "three steps" and HPV detection. And it can guide the proper therapy for CIN.3. The pathogenicity of different HPV genotypes is different. CIN and cervical cancer are closely related to the infection of HPV16.The infection of high-risk HPV (especially HPV16) is more likely to result in hTERC gene amplification than low-risk HPV.4. The value of detecting the expression of hTERC in cervical exfoliated cells by FISH is very important in forecasting recurrence and progress of CIN. It can be used to follow up the patients with CIN who have been gived conservative treatment. The cases with positive expression of hTERC have higher risk of recurrence and metastasis than others, and should be closely followed up. |
PDF Full Text Request