胃黏膜腺体上皮反应性增生与异型增生的判断及临床意义  

Diagnosis and Clinical Significance of Gastric Tunica Mucosa Epithelial Reactive Hyperplasia and Dysplasia

作　　者：胡艳萍[1] 崔莉[1] 杨建杰[1] 刘彤[1] 王秀芳[1] 刘凤阁[1] 

机构地区：[1]首都医科大学潞河教学医院病理科,北京101149

出　　处：《临床误诊误治》2012年第7期65-68,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨胃黏膜腺体上皮反应性增生(gastric epithelial reactive hyperplasia,GERH)及胃黏膜腺体上皮轻度异型增生(gastric epithelial low-grade dysplasia,GELD)的临床病理特征以及P53、增殖细胞核抗原(Ki-67)对于判别两种性质增生的临床意义。方法将我院2010年1月—2011年12月胃黏膜活检组织中伴腺体上皮轻度非典型增生139例,根据Padova及Vienna标准分为GERH组(106例)及GELD组(33例),观察两组病变的组织形态学特点,并分析P53、Ki-67在两组的表达情况。结果 GERH组多伴有明显的炎症背景,腺体增生向黏膜表面或固有膜逐渐分化成熟,无明显的界限;GELD组缺乏炎症背景,且GELD的腺体上皮可延伸至黏膜上皮表面或向下面固有膜及其周围形成界限清楚的局灶状分布。P53在GERH组及GELD组中阳性表达率分别为2.83%及15.15%,两组比较差异有统计学意义(P<0.05)。GERH组中Ki-67阳性表达率24.53%,Ki-67表达位于小凹基底部(下1/3)95例(89.62%);GELD组中Ki-67阳性表达率90.90%,表达位于小凹基底部及侧面(达中1/3)13例(39.39%),两组在表达数量及分布部位方面比较差异有统计学意义(χ2=46.10,P<0.005;χ2=14.83,P<0.005)。结论临床诊断胃黏膜腺体上皮GERH及GELD时,结合组织形态学变化及P53、Ki-67的表达情况可为两者鉴别提供重要依据。Objective To explore the clinicopathologic features and the clinical significance of the P53 and proliferating cell nuclear antigen （Ki-67） expression for gastric epithelial reactive hyperplasia （GERH） and gastric epithelial low grade dysplasia （GELD） . Methods 139 patients with gastric mucosa biopsy combined with epithelial atypical hyperplasia during January 2010 and December 2011 were divided into GERH group （n = 106） and GELD group （n = 33） , based on histomorphology characteristics in pathological change of literature standard. The expression of P53 and Ki-67 in two groups were analyzed. ]Results In GERH group, most of the patients had obvious inflammation history, and reactive hyperplasia showed differentiation gradually to mucosa surface or to inherent membranae without clear boundary. In GELD group there was obviously clear focal distribution without inflam- mation, and epithelial dysplasia could extend to mucosa surface or to inherent membranae. The positive expre~,~sion rate of P53 in GERH group and GELD group were 2.83% and 15.15% respectively, and there was significant difference （P 〈0.05）. In GERH group, the positive expression rate （ 〉 10% ） of Ki-67 was 24.53% （26 patients）, and most of the positive cells located at basal part of gastric pits （under 1/3） were in 95 patients （89.62%）. In GELD group, the positive expression rate （ 〉 10% ） of Ki-67 was 90.90% （30 patients）, and the positive cells located at basal and lateral of gastric pits （at 1/3） were in 13 patients （39. 39% ） , The differences were of statistical significance in expressive amount and distributed positions （X2 =：46.10, P 〈 0. 005 ; X2 = 14.83, P 〈 0. 005）. Conclusion The reactive hyperplasia and low grade dysplasia in gastric epithelial can be differentiated by the clinicopathologic features and expression of P53 and Ki-67.

关 键 词：胃黏膜 活组织检查 反应性增生 异型增生 P53 Ki-67 

分 类 号：R573[医药卫生—消化系统]