CLIC1、IGFBP7在完全性葡萄胎中的表达及其临床价值

Expression of CLIC1 and IGFBP7 in Complete Hydatidiform Mole

中文关键词:  完全性葡萄胎 细胞内氯离子通道1 胰岛素样生长因子结合蛋白7 转归

英文关键词:Complete hydatidiform mole Chloride intracellular channel 1 Insulin-like growth factor binding protein 7 Prognosis

中文摘要:

      目的 探讨细胞内氯离子通道1（CLIC1）和胰岛素样生长因子结合蛋白7（IGFBP7）在完全性葡萄胎（CHM）中的表达及其临床价值。方法 采用免疫组织化学（IHC）染色法检测本院收治的77例葡萄胎（HM）患者的石蜡组织中P57^KIP2的表达，筛选出CHM患者。采用IHC法检测CHM患者的石蜡组织中CLIC1和IGFBP7的表达。结果 ①77例HM中CHM 66例（85.71%），其中14例（21.21%）进展为妊娠滋养细胞肿瘤（GTN）。②CHM恶变组中CLIC1的表达高于良性转归组（P=0.014），恶变组中IGFBP7的表达明显低于良性转归组（P=0.002）。③Pearson 相关分析显示CLIC1与IGFBP7的表达无相关性（P=0.761）。Logistic回归分析结果显示：IGFBP7低表达是CHM恶变的独立危险因素，P=0.005，OR=8.493〔95% 置信区间（CI）：1.878~8.401〕；血清hCG>5×105 mIU/mL是CHM恶变的独立危险因素，P=0.011，OR=11.251（95% CI：1.731~73.151）。④CLIC1的受试者工作特征（ROC）曲线下面积（AUC）为0.707，最佳截断点为10.5分，灵敏度为42.90%，特异度为94.20%。IGFBP7的AUC=0.764，最佳截断点为7.0分，灵敏度为64.30%，特异度为78.80%。将两个指标串联结合，预测CHM恶变的灵敏度21.42%，特异度100%；将两个指标并联结合，灵敏度85.71%，特异度71.15%。结论 CLIC1的表达上调、IGFBP7的表达下调在CHM的恶变中起重要作用，但两者的表达无明显相关性。并联结合两指标的IHC结果预测CHM的恶变的准确性较单一指标有所提高。结合临床高危因素，有望成为早期预测葡萄胎恶变的辅助指标。

英文摘要:

      Objective To investigate the expression level of chloride intracellular channel 1 (CLIC1) and insulin-like growth factor binding protein 7 (IGFBP7) in complete hydatidiform mole (CHM) and estimate the relationship between the expression level and clinical prognosis. Methods Immunohistochemistry (IHC) method was used to detect the expression level of P57^KIP2 in order to differentiate CHM. CLIC1 and IGFBP7 expression level of CHM were measured by IHC method then. Results ① According to the P57^KIP2 expression result 66 patients were diagnosed as CHM (85.71%). Fourteen of 66 patients progressed into gestational trophoblastic neoplasia (GTN), which accounted for 21.21%. ② The results of IHC showed that CLIC1 significantly higher expressed in malignant group than spontaneous regressive group (P=0.014). IGFBP7 significantly down-regulated in malignant group (P=0.002). ③ Pearson correlation analysis results revealed that there were no relation between the expression of CLIC1 and IGFBP7 (P=0.761). Logistic regression analysis indicated that down-regulation of IGFBP7 was the independent risk factors of CHM progression, P=0.005, OR=8.493 〔95% confidence interval (CI): 1.878-38.401〕; Serum hCG>5×10⁵ mIU/mL was the independent risk factors of CHM progression too, P=0.011, OR=11.251 (95% CI: 1.731-73.151). ④ Receiver operator characteristic curve (ROC curve) results showed that the area under the curve (AUC) of CLIC1 was 0.707. The optimum cut off was 10.5, and correspondingly sensitivity was 42.90%, specificity 94.20%. AUC of IGFBP7 was 0.764. The optimum cut off was 7.0, and the correspondingly sensitivity and specificity were 64.30% and 78.80% respectively. Combining the two markers in series, the sensitivity of predicting the prognosis of CHM was 21.42%, while the specificity was 100%. When combining in parallel, the sensitivity and specificity were 85.71% and 71.15% respectively. Conclusion Up-regulation of CLIC1 and down-regulation of IGFBP7 might pay an important role in progression of CHM, but there was no relationship between the expression levels of them. The predictive values of malignance transformation of CHM with the two biomarkers were with certain accuracy, and combining them in parallel test could improve accuracy. They are promising to be candidate prognostic markers of CHM.