CK7、CK20对短节段Barrett食管与贲门部肠上皮化生的诊断价值探讨  

The Value of Cytokeratins 7 and 20(CK7/20) Immunohistochemistry in the Distinction of Short-segment Barrett′s Esophagus from Cardia Intestinal Metaplasia

作　　者：欧阳建东[1] 高靖[1] 程留芳[2] 

机构地区：[1]山东中医药大学第二附属医院,山东济南250001 [2]解放军总医院,北京100853

出　　处：《实用临床医药杂志》2008年第3期49-53,共5页Journal of Clinical Medicine in Practice

摘　　要：目的利用细胞角质蛋白(CK)中的CK7/CK20免疫组化染色反应的不同,对胃镜、病理检查难以区分的短节段Barrett食管(SSBE)及贲门部肠上皮化生(CIM)诊断价值进行探讨。方法根据肠上皮化生(IM)的部位将观察对象分为4组:SSBE伴IM组、CIM组、长节段Barrett食管(LSBE)伴IM组和胃窦部肠上皮化生(GA-IM)组,各组病理检查组织分别进行粘液组织化学AB-PAS、HID-AB染色以及CK7/CK20免疫组织化学染色,并进行各组胃食管反流(GERD)症状及Hp感染情况对比。结果SSBE伴IM与LSBE伴IM CK7/CK20免疫组织化学染色反应相同,以Barrett′s类型为主(72.2%),明显高于CIM(27.3%),差异显著(P<0.01),具有GERD症状者Barrett′s类型发生率(88.9%)较高,明显高于胃类型(14.6%)者,差异有显著意义(P<0.01),CIM与GA-IM CK7/CK20免疫组织化学染色相似,以胃类型为主,与SSBE伴IM及LSBE伴IM比较有显著差异(P<0.01),SSBE伴IM与LSBE伴IM肠化类型主要为Ⅲ型,分别为66.7%,75.0%,与CIM及GA-IM比较差异显著(P<0.01),而CIM与GA-IM肠化类型主要为Ⅰ、Ⅱ型。各组Hp感染率无明显差异(P>0.05)。结论CK7/CK20免疫组化染色反应表现为Barrett′s类型或胃类型对SSBE与CIM的鉴别有重要价值,CK7/CK20免疫组化染色反应表现为Bar-rett′s类型,同时结合有GERD症状,Ⅲ型IM有助于SSBE诊断。反之,CK7/CK20免疫组化染色反应表现为胃类型,无GERD症状,以及Ⅰ、Ⅱ型IM,则提示CIM。Objective To investigate the value of cytokeratin 7/20 （CK7/20） immunoreactivity, mucin histochemistry, clinical characteristics and endoscopy to distinguish short-segment Barrett＇s esophageal （SSBE） from cardiac intestinal metaplasia （CIM）. Methods High iron diamine/Alcian blue （HID/AB） mucin-histochemical staining and immunohistochemical staining were used to classify intestinal metaplasia （IM） and to determine CK7/20 immunoreactivity pattern in SSBE and CIM respectively, and these results were compared with endoscopical diagnosis and the positive rate of gastroesophageal reflux disease （GERD） symptoms and H pylori infection. Longsegment Barrett＇s esophageal and IM of gastric antrum were designed as control. Results The prevalence of type III IM was significantly higher in SSBE than in CIM （66.7% vs 27.3%, P〈0. 05）. The CK7/20 immunoreactivity in SSBE showed mainly Barrett＇s pattern （72.2%）, and the GERD symptoms in most cases which showed Barrett＇s pattern were positive. GERD symptoms ingastric pattern were significantly lower than that in Barrett ＇ s pattern （ 1 4. 6 % vs 8 8. 9 % , P〈0.05）. The CK7/20 immunoreactivity in CIM was gastric pattern preponderantly （68.1% ）, but there were 27.3% cases that showed Barrett＇s pattern. There were no statistical difference for the incidence of H pylori infection which were almost same high in all groups. Conclusions Distinction of SSBE from CIM should not be based on a single method; The combination of clinical characteristics, histology, mucin histochemistry, CK7/20 i mmunoreactivity, and endoscopic biopsy should be applied. Type Ⅲ IM, presence of GERD symptoms, and Barrett＇s CK7/20 immunoreactivity pattern may support the diagnosis of SSBE, whereas non-type Ⅲ IM and gastric CK7/20 immunoreactivity pattern may imply CIM.

关 键 词：短节段BARRETT食管 贲门部肠上皮化生 CK7 CK20 

分 类 号：R446.6[医药卫生—诊断学]