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骨纖維結構不良病變組織雌激素受體和增殖細胞核抗原檢測及臨床意
作者：牛彥輝，王臻，鄭修存，吳作棟，沈強，張立明【關鍵詞】 ,,纖維發育不良
Detection and significance of estrogen receptor and proliferating cell nuclear antigen in tissues of fibrous dysplasia of bone
【Abstract】 AIM: To investigate the relation between the clinical biological behavior and the expression of estrogen receptor (ER) and proliferating cell nuclear antigen (PCNA) in the tissues of fibrous dysplasia of bone (FDB). METHODS: Ninetyeight cases wrer surgically treated, pathologically confirmed as having fibrous dysplasia and followed up. The primary operation specimens were randomly selected and divided into recurrence group (n=24) and cured group (n=24), children group (n=26) and adult group(n=22). The ER and PCNA in the specimens were detected with monoclonal antibody to ER or PCNA by immunohistochemistry. RESULTS: The general positive expression rate of ER was 56.25%(27/48). The positivity rate in recurrence group was higher than that in cured group (70.83% vs 41.67%, P＜0.05) and the positivity rate in children group was higher than that in adult group (69.23% vs 40.91%, P＜0.05). The expression of PCNA in recurrence group was higher than that in cured group (P＜0.01). The expression of PCNA had a tendency to be higher in children group than that in adult group, but with no statistical significance (P＞0.05). CONCLUSION: FDB is relative to the estrogen. The abnormal expression of ER, the disturbance of the regulation of estrogen in bone development and metabolism may be the causes of the onset and recurrence of FDB. The expression of PCNA is related with the recurrence of FDB. PCNA can be used as a reference marker for prognosis of FDB.
【Keywords】 fibrous dysplasia of bone; receptors estrogen; proliferating cell nuclear antigen(PCNA); immunohistochemistry
【摘要】 目的： 探討骨纖維結構不良（FDB）病變組織雌激素受體（ER）和增殖細胞核抗原（PCNA）的表達并討論其臨床意義. 方法： 98例FDB患者手術治療、病理確診并獲隨訪. 收集初次手術切除的標本，隨機從治愈和復發病例中各抽取24例. 對復發組（n=24）與治愈組（n=24）、小兒組（n=26）與成人組（n=22）進行對比，用單克隆抗體免疫組織化學方法對病變組織進行ER和PCNA檢測. 結果： ER總陽性率為56.25%(27/48). 復發組70.83%（17/24）明顯高于治愈組41.67%(10/24) （P＜0.05）. 小兒組69.23%(18/26)明顯高于成人組40.91%(9/22， P＜0.05). 復發組PCNA陽性表達強度顯著高于治愈組(P＜0.01)，而小兒組PCNA陽性表達高于成人組，但無統計學差異(P＞0.05). 結論： FDB的雌激素相關性表現為ER異常表達而導致骨發育及代謝調節紊亂；PCNA陽性表達強度與骨纖維結構不良的復發密切相關，可作為其預后估測的參考指標.
【關鍵詞】 纖維發育不良，骨；受體，雌激素；增殖細胞核抗原；免疫組織化學
0引言
骨纖維結構不良（fibrous dysplasia of bone, FDB）的發病率居骨與關節瘤樣病變的首位［1］，其臨床表現為，術后復發率高，兒童期更具高度復發傾向和侵襲性，部分病灶呈進展性，部分病灶卻長期靜止，有些病例反復多次復發，少數可發生惡變，但泛發性骨纖維結構不良（Albright綜合征）主要見于女性. 我們檢測骨纖病變組織中雌激素受（estrogen receptor, ER）和增殖細胞核抗原（proliferating cell nuclear antigen, PCNA）的變化并討論其臨床意義.
1材料和方法
1.1材料
標本來源于197701/199806西京醫院骨科手術治療的骨纖患者病變組織石蠟埋塊. 選取其中有隨訪結果的98例患者初次手術標本，根據隨訪結果分成復發與治愈兩組. 采用隨機數字法各選取24個標本，共48例. 再根據患者年齡分為：小兒組（≤14歲）26例，成人組（≥15歲）22例. 一抗分別選用法國Immunotech公司產的鼠抗人ER mAb（1∶50）和丹麥DAKO公司產的鼠抗人PCNA mAb(1∶40). 二抗均選用Sigma公司產的生物素標記羊抗鼠IgG. SABC試劑盒(武漢博士德生物工程有限公司).
1.2方法
標本連續切片3張，1張HE染色，病理醫師再次確診，2張分
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