结肠高危性腺瘤的临床分析及Decorin在腺瘤中的表达与意义  

Clinical Analysis of Colorectal Advanced Adenomas and Expression of Decorin in Colon Polyps

作　　者：王少军[1] 胡乃中[1] 石海[1] 曹富流[1] 

机构地区：[1]安徽医科大学第一附属医院消化内科,合肥市230022

出　　处：《中国肿瘤临床》2010年第12期685-688,共4页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨结肠高危性腺瘤的临床病理特征及Decorin在结肠腺瘤中的表达与意义。方法:对安徽医科大学第一附属医院2005年1月～2008年11月收治的结肠息肉患者按照2006年美国《大肠息肉切除术后随访指南》进行风险分层并进行临床病理分析;采用免疫组化方法分别检测Decorin蛋白在20例正常组织、18例结肠癌和86例结肠息肉中的表达情况。结果:583例结肠息肉患者中,非腺瘤性息肉243例,低危腺瘤83例,高危腺瘤257例。腺瘤性息肉组平均年龄(58.9±13.3)岁,高于非腺瘤性息肉组(55.5±15.7)岁(P<0.05);腺瘤性息肉组中其息肉直径≥1cm和数量≥3个者均高于非腺瘤性息肉组(P<0.01);腺瘤性息肉癌变率为9.1%,非腺瘤性息肉为0.8%(P<0.001)。高危腺瘤较非高危腺瘤组便血症状更多,在内镜下更易观察到黏膜改变和表面分叶(P<0.05)。Decorin在正常组织和非腺瘤性息肉以及管状腺瘤中呈高表达,而在含绒毛状结构、高度异型性的腺瘤和癌组织中低表达;Decorin的表达与腺瘤的病理类型与异型增生程度呈相关性(P<0.05)。结论:结肠高危息肉在临床症状及内镜下都具有一定形态特征,对结肠息肉切除后的规范筛查、诊断和合理随访具有指导意义;Decorin蛋白的检测可作为一种有价值的指标,用于息肉恶性程度的评价。Objective： To investigate the endoscopic and pathologic characteristics of colorectal high-risk adenomas and the significance of decorin expression in colorectal adenomas. Methods： The risk status and characteristics of colon polyp patients, treated in our hospital over a period of nearly 3 years, were analyzed retrospectively, according to the 2006 Postpolypectomy Colonoscopy Surveillance Guidelines. Immunohistochemistry was used to detect decorin protein in 20 cases of normal tissue, 18 cases of colon cancer and 86 cases of colon polyp. Results： The number of patients with colonic polyps was 583, including 243 cases of non-adenomatous polyp, 83 cases of low-risk adenoma, and 257 cases of high-risk adenoma. The average age of adenomatous polyp patients was older than that of the non-adenomatous polyp patients （58.9±13.3 vs. 55.5±15.7, P〈0.05）; adenomatous polyp patients whose polyp diameters≥1cm and quantity ≥3 pieces of adenomas were older than non-adenomatous polyp patients （P〈0.01）, with a significant difference （9.1% vs. 0.8%, P〈 0.001）. The high-risk adenomas had a higher incidence of hematochezia, more Iobular and mucosal pathological changes than low-risk adenomas （P〈0.05）. Normal tissue and non-adenomatous polyps and the majority of tubular adenomas showed strong expression of decorin in the stroma. Adenomas with villous features and high grade colon intraepithelial neo- plasia and adenocarcinoma showed moderate and very low decorin immunoreactivity （P〈0.05）. Decorin expression levels were significantly related to histological features and the dysplasia grade of adenomas （P〈0.05）. Conclusion： Characteris- tics of colorectal advanced adenomous polyps were provided for the appropriate surveillance colonoscopy of postpolypectomy. The test of expression of decorin protein was helpful in assessing the malignant extent of colorectal polyps.

关 键 词：结肠息肉 DECORIN 高危腺瘤 

分 类 号：R735.3[医药卫生—肿瘤]