摘要目的 探讨多种蛋白:增殖细胞相关的核抗原(Ki67)、肿瘤抑制基因p53、细胞角蛋白(CKL)、上皮膜抗原(EMA)、酸性钙结合蛋白S-100、神经元特异性烯醇酶(NSE)、嗜铬素A(CgA)、突触素(syn)、癌胚抗原(CEA)和肿瘤转移抑制基因nm23在肾上腺肿瘤组织中的表达及临床意义.方法 应用单克隆抗体免疫组化技术链霉菌抗生物素蛋白-过氧化酶连接法(S-P法)检测163例肾上腺肿瘤组织中多种蛋白的表达,并收集患者的一般资料,包括患者年龄、临床症状、检验结果、病理类型等,进行统计学处理.所有资料应用SAS 6.12软件分析处理,以P＜0.05作为检验标准. 结果 CKL、S-100,NSE、CgA、Syn、nm23在肿瘤组织中表达明显升高(P＜0.05).S-100、CgA、Syn表达与病理类型显著相关(P＜0.05),3种蛋白表达两两互呈正相关性(P＜0.01).CKL,S-100、NSE、CgA、Syu、nm23在肾上腺良恶性肿瘤中的表达无差异(P＜0.05),但明显高于正常肾上腺组织(P＜0.05).Syn在肾上腺皮质腺瘤中的表达明显高于皮质腺癌(P＜0.05),Ki67在肾上腺皮质腺瘤中的表达明显低于皮质腺癌(P＜0.05).EMA、CKL在肾上腺皮质肿瘤中的表达明显高于髓质肿瘤(P＜0.05),S-100、Syn、NSE、CgA在肾上腺皮质肿瘤中的表达明显低于髓质肿瘤(P＜0.05). 结论 CKL、S-100、NSE、CgA、Syn、nm23这6种蛋白为肾上腺肿瘤的良好标志物,可用于肾上腺肿瘤的定性诊断.联合检测Syn和Ki-67对肾上腺皮质肿瘤的鉴别诊断有重要的参考价值.联合检测EMA、CKL、S-100、Syn、NSE及CgA并紧密结合临床则有助于皮髓质肿瘤的鉴别.

abstractsObjective To investigate the expressions of Ki67,p53,CKL,EMA,S-lOO,NSE,CgA,Syn,CEA and nm23 in adrenal tumors and their clinical significance.Methods Clinical data from 157 cases of adre-nal tumor patients were retrospectively reviewed including the clinical informa-tion and pathology data.Expressions of Ki67,p53,CKL,EMA,S-100,NSE,CgA,Syn,CEA and nm23 proteins were studied by immunohistochemistry(SP method)using monoclonal antibodies,and the relationship of their expressions with histopathologic type and clinical imformation was analyzed with SAS v6.12 software.A P value of＜0.05 was considered statistically significant.Results A increase of the expression rate of CKL,S-100,NSE,CgA,Syn and nm23 in adrenal tumors was obsered(P＜0.05).For univariate analysis,the expression of S-100,CgA,Syn was in connection with histopathologie types(P＜0.05).The expression of S-100,CgA,Syn had positive correlation with each other.The expression of CKL,S-100,NSE,CgA,Syn,nm-23 was no difference between adrnalbenign tumors and malignant tumors(P＞0.05),but it was much higher than in normal adrenal tissues(P＜0.05).The expression of Syn in adrenal cortical adenomaa was higher than in adrenal cortical cancers(P＜0.05),the expression of Ki67 in adrenal cortical adenomas was much lower than in adrenal cortical cancers(P＜0.05).The expression of EMA、CKL in adrenal cortical tumors were higher than in adrenal medullary tumors(P＜0.05),the expression of S-100,Syn,NSE,CgA in adrenal cortical tumors were lower than in adrenal medullary tumors(P＜0.05).Conclusions CKL,S-100,NSE,CgA,Syn and nm23 were good markers for adrenal tumors,they could be use for the adrenal tumors diagnosis.Detect Syn and Ki67 simutaneously was helpful to the diagnosis of adrenal cortical tumors.Detect EMA,CKL,S-100,Syn,NSE and CgA simultaneously and combine with clinical data was helpful to diagnosis between adrenal cortical tumors and adrenal medullay tumors.In malignant tumors,blood pressure had positive correlation with the expression of CgA,the size of tumor had neg-ative correlation of blood pressure,no prognostic factor was found.