结肠黑变病内镜表现与癌基因检测联合应用探讨  

Clinical application of endoscopic findings and expression of oncogene in melanosis coli.

作　　者：徐光辉[1] 仇敏洁[2] 李慧敏[3] 凌国敏[3] 刘斌[1] 王泽衍[1] 

机构地区：[1]上海市闸北区中心医院消化科 [2]上海市闸北区中心医院病理科上海200070 [3]上海市闸北区中心医院内镜室

出　　处：《海南医学》2013年第22期3298-3300,共3页Hainan Medical Journal

基　　金：上海市闸北区医学科研课题重点项目--区科委资助(编号:2009ZBMXKZG03)

摘　　要：目的 研究结肠黑变病（Melanosis coli,MC）内镜下表现与黏膜组织大肠癌相关癌基因（APC、Bcl-2、K-ras、Ki-67、Cox-2）表达的联合应用,探讨MC病变的严重程度及其癌变风险的相关性.方法 选取通过全结肠镜检出并经病理活检证实的MC患者108例,另选取正常黏膜者50例作为对照（均为肠镜检查和病理证实）,同时行黏膜组织相关癌基因（APC、Bcl-2、K-ras、Ki-67、Cox-2）的单克隆基因蛋白免疫组化检测.结果 与正常黏膜者比较,MC内镜下病变程度加剧与APC、Bcl-2、K-ras、Ki-67、Cox-2的表达水平存在相关性,病变程度越重,APC阳性表达趋向越低,Bcl-2、K-ras、Ki-67、Cox-2阳性表达趋向越高,差异均有统计学意义（P＜0.05）;Bcl-2、K-ras、Ki-67、Cox-2的表达高低依次为MC伴肠癌组、MC伴息肉组、MC Ⅰ～Ⅲ度、正常黏膜组.APC阳性表达高低依次为正常黏膜与MCⅠ～Ⅱ度、MCⅢ度与MC伴息肉组、MC伴肠癌组.结论 MC病变程度加剧,其癌变风险可能越大.重视MCⅢ度、MC伴息肉,将MC内镜下表现与大肠癌相关癌基因监测联合应用,可提高基层医院早期大肠癌的诊治水平,可作为切实可行的MC内镜下随访策略.Objective To study the endoscopic findings of melanosis coli （MC） and the rules of the expression of oncogene APC,Bcl-2,K-ras,Ki-67 and Cox-2 in MC,and to explore the relationship between the severity of MC and the risks of cancer.Methods One hundred and eight patients of MC selected by colonoscopy,histopathology and special staining confirmed were enrolled in the study （MC group）.Besides,50 subjects of normal colorectal mucosa were selected as the control group.Immunohistochemistry method was used to examine the expression of APC,Bcl-2,K-ras,Ki-67 and Cox-2 in MC group and the control group.Results Compared with the control group,the MC endoscopic varying degrees was correlated to the positive expression rate of Bcl-2,K-ras,Ki-67 and Cox-2.The severer the MC endoscopic varying degrees,the lower the positive expression rate of APC and the higher the positive expression rate of Bcl-2,K-ras,Ki-67,Cox-2,with statistically significant difference （P〈0.05）.The positive expression rate of Bcl-2,K-ras,Ki-67,Cox-2 was the highest in MC with cancer subgroup,followed by MC with polyps subgroup,MCⅠ～ Ⅲ subgroup,and the control group （P〈0.05）.The positive expression rate of APC was the highest in the control group and MC Ⅰ～ Ⅱ subgroup,followed by MC Ⅲ subgroup and MC with polyps subgroup,MC with cancer and（P〈0.05）.Conclusion As the severity of MC increased,the risk of cancer might be higher.For the patients with MC Ⅲ and MC with polyps,combined examination of endoscopic findings and expression of oncogene is practical and can improve the level of the diagnosis and treatment of early colorectal carcinoma in primary hospital.

关 键 词：结肠黑变病 肠镜 免疫组化 

分 类 号：R574.62[医药卫生—消化系统]