安徽医科大学学报

目的探讨半乳糖凝集素3(Galectin-3)、细胞角蛋白19(CK19)、人骨髓内皮细胞标记物(HBME-1)蛋白表达和鼠类肉瘤滤过性毒菌致癌同源体B1(BRAF)基因突变在甲状腺乳头状癌(PTC)中的意义。方法采用免疫组化Envision法检测82例PTC和82例甲状腺良性病变中Galectin-3、CK19、HBME-1蛋白表达状况;采用聚合酶链反应及DNA测序法检测60例PTC和60例甲状腺良性病变中BRAF基因突变状况。结果①82例PTC中HBME-1、Galectin-3和CK19的阳性表达率分别为98.8%、97.6%、100%,与甲状腺良性病变比较,差异有统计学意义(P<0.05),而与临床病理参数间无相关性;另外联合检测3项蛋白指标,并以HBME-1联合CK19或Galectin-3同时表达作为PTC诊断标准时,敏感度可高达99.9%,特异度达95.4%;②60例PTC中BRAF基因突变率为66.7%,与甲状腺良性病变比较,差异有统计学意义(P<0.05),与临床病理参数间无相关性。结论①蛋白标记物Galectin-3、CK19、HBME-1对PTC的诊断均有一定病理价值,其中以HBME-1最为理想,联合检测特异度敏感性更佳;②BRAF基因突变是PTC发生的一项重要事件,对其确诊可能具有重要意义。

Objective To explore the significance of expressions of HBME-1,Galectin-3,CK19 and BRAF mutation in papillary thyroid carcinoma(PTC).Methods Immunohistochemical staining was performed in 82 specimens of PTC and 82 specimens of papillary benign lesions to examine the expression of HBME-1,Galectin-3 and CK19;polymerase chain reaction(PCR) and gene sequencing were performed in 60 specimens of PTC and 60 specimens of papillary benign lesions to detect BRAF mutation.Results ① The positive ratios of HBME-1,Galectin-3 and CK19 in PTC were 98.8%,97.6% and 100%,which were significantly higher than expression levels of papillary benign lesions(P < 0.05).There were no relationships between expression of these makers and the clinicopothological features in PTC.When combining these three protein makers,co-expression of HBME-1 and CK19 or HBME-1 and Galectin-3 was seen in 99.9% of PTC,respectively,and the specificity can reach 95.4% if this staining result was chosen as diagnostic criteria of PTC.② BRAF mutation was detected in 40 of 60 PTC with a detection rate of 66.7%.There was statistical difference in BRAF mutation between PTC and papillary benign lesions(P < 0.05) and no relationships between BRAF mutation and the clinicopothological features in PTC.Conclusion ① HBME-1 has the remarkable significance among three protein makers,all of which can be of important value in differential diagnosis of PTC;combination of immunohistochemical staining of HBME-1,galectin-3 and CK19 can make further improvement on the sensitivity and specificity;② BRAF mutation is may have diagnostic value for PTC.