p53、p57联合短串联重复序列基因分型在葡萄胎诊断中的应用

Application of p53 and p57 combined with short tandem repeat genotyping in diagnosis of hydatidiform mole

摘要:

目的 探讨p53、p57联合短串联重复序列基因分型在葡萄胎诊断中的应用价值。方法 选取2017年3月—2020年3月赣州市妇幼保健院收治的经病理检查确诊的46例完全性葡萄胎患者，34例部分性葡萄胎患者，以及26例水肿性流产患者作为研究对象。获取所有患者的组织标本，采用免疫组织化学法检测p53、p57蛋白表达，采用短串联重复序列基因分型试剂盒进行基因分型检测，采用Kappa一致性检验分析p53、p57联合短串联重复序列基因分型与病理诊断对诊断葡萄胎的一致性。结果 完全性葡萄胎绒毛间质明显水肿，且有水池形成，滋养叶细胞明显增生；部分性葡萄胎绒毛间质轻微水肿，可见有水池，滋养细胞包涵体形成，滋养叶细胞轻度或中度增生；水肿性流产绒毛间质轻微水肿，滋养叶细胞增生不明显。完全性葡萄胎中41例p53阳性，阳性率为89.13%；部分性葡萄胎中27例p53阳性，阳性率为79.41%；水肿性流产中3例p53阳性，阳性率为11.54%。完全性葡萄胎中0例p57阳性，阳性率为0.00%；部分性葡萄胎中30例p57阳性，阳性率为88.24%；水肿性流产中26例p57阳性，阳性率为100.00%。41例完全性葡萄胎短串联重复序列基因分型诊断结果与病理诊断相符，符合率为89.13%；31例部分性葡萄胎短串联重复序列基因分型诊断结果与病理诊断相符，符合率为91.18%；25例水肿性流产短串联重复序列基因分型诊断结果与病理诊断相符，符合率为96.15%；所有患者总符合率为91.51%，经Kappa一致性检验，2种诊断方法具有较好的一致性（κ =0.755，P =0.000）；44例完全性葡萄胎p53、p57联合短串联重复序列基因分型诊断结果与病理诊断相符，符合率为95.65%；32例部分性葡萄胎p53、p57联合短串联重复序列基因分型诊断结果与病理诊断相符，符合率为94.12%；25例水肿性流产p53、p57联合短串联重复序列基因分型诊断结果与病理诊断相符，符合率为100.00%；所有患者总符合率为96.23%，经Kappa一致性检验，2种诊断方法具有较好的一致性（κ =0.804，P =0.000）。结论 p53、p57联合短串联重复序列基因分型用于葡萄胎诊断具有重要价值。

Abstract:

Objective To explore the value of p53 and p57 combined with short tandem repeat genotyping in the diagnosis of hydatidiform mole.Methods Forty-six patients with complete hydatidiform mole, 34 patients with partial hydatidiform mole, and 26 patients with edematous abortion who were diagnosed by pathological examination from March 2017 to March 2020 in the hospital were selected as the research objects, and tissue samples were obtained. The expression of p53 and p57 protein was detected by immunohistochemistry. With short tandem repeat genotyping for typing detection, the value of p53 and p57 combined with short tandem repeat genotyping in the diagnosis of hydatidiform mole was analyzed.Results The villous stroma of complete hydatidiform mole was obviously edematous, and water pool was formed, and trophoblast cells were obviously proliferated; In some hydatidiform moles, the villous stroma showed slight edema, with pools, trophoblastic inclusion bodies formed, and trophoblastic cells slightly or moderately proliferated; There was slight edema in villous stroma of edematous abortion, and the proliferation of trophoblast cells was not obvious. P53 was positive in 41 cases of complete hydatidiform mole (89.13%); P53 was positive in 27 cases of partial hydatidiform mole (79.41%); P53 was positive in 3 cases of edema abortion, the positive rate was 11.54%. P57 was positive in 0 cases of complete hydatidiform mole, the positive rate was 0.00%; 30 cases of partial hydatidiform mole were positive for p57, the positive rate was 88.24%; P57 was positive in 26 cases of edema abortion, the positive rate was 100.00%. The genotyping results of 41 cases of complete hydatidiform mole with short tandem repeats were consistent with pathological diagnosis, with a coincidence rate of 89.13%; The genotyping results of 31 cases of partial hydatidiform mole with short tandem repeats were consistent with pathological diagnosis, with a coincidence rate of 91.18%; The genotyping results of short tandem repeat (STR) in 25 cases of edema abortion were consistent with pathological diagnosis, with a coincidence rate of 96.15%; The total coincidence rate of all patients was 91.51%. Through Kappa consistency test, the two diagnostic methods had good consistency ( κ = 0.755, P =0.000); The genotyping results of p53 and p57 combined with short tandem repeats in 44 cases of complete hydatidiform mole were consistent with pathological diagnosis, with a coincidence rate of 95.65%; The genotyping results of p53 and p57 combined with short tandem repeats in 32 cases of partial hydatidiform mole were consistent with pathological diagnosis, with a coincidence rate of 94.12%; The results of p53 and p57 combined with short tandem repeats in 25 cases of edema abortion were consistent with pathological diagnosis, with a coincidence rate of 100.00%; The total coincidence rate of all patients was 96.23%. Through Kappa consistency test, the two diagnostic methods had good consistency (κ = 0.804, P = 0.000).Conclusion The p53 and p57 combined with short tandem repeats was of great value in the diagnosis of hydatidiform mole.