放大胃镜联合增殖细胞核抗原和p53对胃癌癌前病变的诊断价值  

The Value of Magnifying Gastroscopy Combined with Proliferating Cell Nuclear Antigen and p53 on Diagnosing Precancerous Ggastric Lesions

作　　者：刘伟[1] 吴益怀[1] 陈玉芬[1] 李志红[1] 蒋水英[1] 

机构地区：[1]郴州市第一人民医院南院消化科,郴州423000

出　　处：《临床消化病杂志》2010年第5期264-266,272,共4页Chinese Journal of Clinical Gastroenterology

摘　　要：目的探讨放大胃镜、增殖细胞核抗原(PCNA)、p53在胃黏膜癌前病变中的诊断价值。方法应用放大胃镜对180例病人进行检查,放大胃镜下做出实时诊断,取活组织分别送病理学检查和免疫组化法检测PCNA和p53的表达。放大胃镜下胃小凹分为A、B、C、D、E5型[1]。结果放大胃镜下B～E4种胃小凹形态肠上皮化生发生率差异有统计学意义(χ2=16.24,P<0.05),并且肠上皮化生的严重程度逐渐加重(相关系数=0.612,P<0.05):C～E3种胃小凹形态与不典型增生的严重程度关系密切(χ2=11.31,相关系数=0.637,P<0.05):B、C、D、E等4型胃小凹形态间PCNA和p53表达量差异有统计学意义(F=6.514,P<0.05)。结论放大胃镜下胃黏膜微细结构形态可反映病变程度的轻重,PCNA和p53是重要的胃癌标志物,随访E型胃小凹、高PCNA和p53表达的患者有助于早期发现胃癌。Objective To investigate the diagnostic value of magnifying gastroscopy combined with proliferating cell nuclear antigen（PCNA） and p53 on identifying precancerous lesions of gastric mucosa. Methods There were 180 patients with upper digestive symptoms were recruited in the study. They were examined by the same senior doctor by using magnifying gastroscopy, and real-time diagnosis was made during the examination. Bopsies were taken for pathological examination and the expressions of PCNA and p53 were measured by immunohistochemical staining analysis. The morphology of gastric pits patterns under magnifying gastroscopy was classified as follows： type A： round spot pits, type B： linear, type C： sparsely and thickly linear, typed D： patchy, and type E： villous. Results The difference of intestinal metaplasia was statistically significant among the gastric pit patterns from B to E under magnifying endoscopy（χ^216.24, P〈0.05） . The more severe the intestinal metaplasia, the higher the pattern scale of the gastric pit （r=0. 612,P〈0.05）.The degree of dysplasia had a parallel relationship with the gastric pit patterns changed from C to E （χ^211.31, r=0. 637,P〈0.05）. The expressions of PCNA and p53 of mucosa had significant differences among the gastric pit patterns B, C, D and E（F=6. 514, P〈0.05）.Conclusion The micro-structural changes of gastric mucosa under magnifying gastroscopy can reflect the severity of gastric diseas. PCNA and p53 are very important markers for diagnosis of gastric carcinoma. It is useful to predict the malignant change of gastric precancerous lesions in patients by following up high expression of PCNA and p53 combined with pit type E diagnosed by magnifying gastroscopy.

关 键 词：胃癌 胃黏膜 增殖细胞核抗原 P53 放大胃镜 

分 类 号：R735.2[医药卫生—肿瘤]