食管下段柱状上皮岛临床病理特点研究  

Clinical and histopathologic analysis of the columnar-lined islands in the lower esophagus

作　　者：崔荣丽[1] 周丽雅[1] 闫秀娥[1] 金珠[1] 张贺军[1] 夏志伟[1] 徐志洁[1] 王晔[1] 尚惠茹[1] 韩亚京[1] 张颖[1] 葛颖[1] 林三仁[1] 

机构地区：[1]北京大学第三医院消化科,北京100191

出　　处：《中华消化内镜杂志》2015年第1期18-23,共6页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨食管下段柱状上皮岛（CLI）的临床和病理特点以及与Barrett食管（BE）的关系。方法回顾性收集2005年至2013年438例食管下段CLI患者的病例资料，总结内镜下形态学特点及活检病理组织学特点。对比分析27例CLI患者和23例非岛型（环周型或舌型）BE患者的阿尔辛蓝-过碘酸雪夫（AB／PAS）组织化学染色及MUC-2、MUC-6、CDX2、Ki-67免疫组化染色结果，31例CLI患者和28例非岛型BE患者的24h食管pH-阻抗监测结果。结果CLI发现率以40-〈50岁最高（0．61％，104／17164），其次为50-〈60岁（0．49％，107／21794）。438例食管下段CLI患者中，CLI距齿状线距离≤0．5cm者323例（占73．7％），单发266例（占60．7％），最大直径〈0．5cm者338例（占81．8％），幽门螺杆菌阳性者147例（占33．7％），单纯贲门型黏膜220例（占62．5％）。27例CLI患者和23例非岛型BE患者的黏膜AB／PAS组织化学染色及MUC-2、MUC-6、CDX2、Ki-67免疫组化染色结果分析未见两者黏液特点、细胞增殖情况方面差异有统计学意义。31例CLI患者和28例非岛型BE患者的24h食管pH-阻抗监测结果分析未发现两者在典型症状、食管远端反流情况方面差异有统计学意义。结论食管下段CLI以40～〈50岁人群好发，CLI多位于齿状线上0．5cm范围，多单发，最大直径多小于0．5cm，固有腺体多为黏液腺，黏膜固有腺的黏液特点以及反流情况与非岛型BE相似，推测可能是BE的早期阶段。Objective To analyze the endoscopic and histopathologic characteristics of columnarlined island（CLI） type of Barrett esophagus （BE） in the lower esophagus. Methods Data of 438 patients with CLI from 2005 to 2013 were reviewed, and endoscopic and histopathological characteristics were analyzed retrospectively. Immunohistochemical staining and AB/PAS staining were performed in 27 samples in CLI and 23 samples in non-island type BE. All the samples were observed by the pathologist and then analyzed. Twenty-four hour pH-impedance monitoring was conducted in 31 subjects with CLI and 28 subjects with non-island type BE. Results The highest incidence of CLI was found in patients aged from 40 to 〈 50 （0. 61% ,104/17 164）, followed by age 50 to 〈60（0. 49% ,107/21 794）. There were 323 patients whose CLIs were within 0. 5 cm above Z-line（73.7% ）, 266 subjects with single CLI, maximum diameter shorter than 0. 5 cm of CLI in 338（81.8% ）. One hundred and forty-seven got Hp infection（33.7% ）. There were 220（62. 5% ） gastric cardiac glandular type. There was no significant difference in AB/PAS staining, MUC- 6, MUC-2, CDX2 and Ki-67 immunohistochemieal staining between the CLIs （ n = 27 ） and non-island type BEs （without intestinal metaplasia）. According to the pH impedance monitoring, no differences were found in the reflux parameters and the typical reflux symptoms between two groups. Conclusion CLIs in the loweresophagus are common among people aged 40- 〈 50, located within 0. 5 cm above the Z-line, single, maxi- mum diameter shorter than 0. 5 cm, and with gastric cardiac glandular. There are no significant differences in the mucus expression, and the reflux parameters in CLIs and non-island type BEs.

关 键 词：BARRETT食管 柱状上皮岛 肠上皮化生 胃食管反流病 pH阻抗监测 

分 类 号：R655.4[医药卫生—外科学]