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骨纤维结构不良病变组织雌激素受体和增殖细胞核抗原检测及临床意
作者：牛彦辉，王臻，郑修存，吴作栋，沈强，张立明【关键词】 ,,纤维发育不良
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： 探讨骨纤维结构不良（FDB）病变组织雌激素受体（ER）和增殖细胞核抗原（PCNA）的表达并讨论其临床意义. 方法： 98例FDB患者手术治疗、病理确诊并获随访. 收集初次手术切除的标本，随机从治愈和复发病例中各抽取24例. 对复发组（n=24）与治愈组（n=24）、小儿组（n=26）与成人组（n=22）进行对比，用单克隆抗体免疫组织化学方法对病变组织进行ER和PCNA检测. 结果： ER总阳性率为56.25%(27/48). 复发组70.83%（17/24）明显高于治愈组41.67%(10/24) （P＜0.05）. 小儿组69.23%(18/26)明显高于成人组40.91%(9/22， P＜0.05). 复发组PCNA阳性表达强度显著高于治愈组(P＜0.01)，而小儿组PCNA阳性表达高于成人组，但无统计学差异(P＞0.05). 结论： FDB的雌激素相关性表现为ER异常表达而导致骨发育及代谢调节紊乱；PCNA阳性表达强度与骨纤维结构不良的复发密切相关，可作为其预后估测的参考指标.
【关键词】 纤维发育不良，骨；受体，雌激素；增殖细胞核抗原；免疫组织化学
0引言
骨纤维结构不良（fibrous dysplasia of bone, FDB）的发病率居骨与关节瘤样病变的首位［1］，其临床表现为，术后复发率高，儿童期更具高度复发倾向和侵袭性，部分病灶呈进展性，部分病灶却长期静止，有些病例反复多次复发，少数可发生恶变，但泛发性骨纤维结构不良（Albright综合征）主要见于女性. 我们检测骨纤病变组织中雌激素受（estrogen receptor, ER）和增殖细胞核抗原（proliferating cell nuclear antigen, PCNA）的变化并讨论其临床意义.
1材料和方法
1.1材料
标本来源于197701/199806西京医院骨科手术治疗的骨纤患者病变组织石蜡埋块. 选取其中有随访结果的98例患者初次手术标本，根据随访结果分成复发与治愈两组. 采用随机数字法各选取24个标本，共48例. 再根据患者年龄分为：小儿组（≤14岁）26例，成人组（≥15岁）22例. 一抗分别选用法国Immunotech公司产的鼠抗人ER mAb（1∶50）和丹麦DAKO公司产的鼠抗人PCNA mAb(1∶40). 二抗均选用Sigma公司产的生物素标记羊抗鼠IgG. SABC试剂盒(武汉博士德生物工程有限公司).
1.2方法
标本连续切片3张，1张HE染色，病理医师再次确诊，2张分
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