不同分化程度胃癌与内镜下自发荧光光谱的关系  

The correlation of endoscopic autofluorescence spectrum with differentiation of gastric cancer

作　　者：陈颖[1] 吴云林[1] 吴巍[1] 蔚青[2] 燕敏[3] 王晓瑾[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院消化科,上海200025 [2]上海交通大学医学院附属瑞金医院病理科,上海200025 [3]上海交通大学医学院附属瑞金医院外科,上海200025

出　　处：《内科理论与实践》2015年第2期119-122,共4页Journal of Internal Medicine Concepts & Practice

摘　　要：目的 ：研究体内不同分化程度胃癌的自发荧光光谱表现特征,初步探索提高自发荧光光谱诊断准确性的方法。方法：纳入2010年1月至12月我院88例患者,均接受了普通胃镜检查和激光诱发自发荧光光谱检测,其中内镜病理诊断为胃癌者73例,慢性胃炎者15例。在400~700 nm间每隔50 nm测定1个荧光样本。病灶和邻近组织正常黏膜分别取活组织检查（活检）,病理提示胃癌的患者进行外科手术治疗。胃癌患者根据分化程度分组,比较不同病理类型胃癌的自发荧光值差异。结果：73例胃癌患者根据胃癌分化程度分成3组,高分化胃癌组（H组）32例,中分化胃癌组（M组）16例,低分化胃癌组（L组）25例。15例慢性胃炎患者均为慢性萎缩性胃炎,为良性胃炎组。在450~550 nm波段,荧光强度与胃癌分化程度呈正相关（r450 nm=0.653,P〈0.01;r500 nm=0.712,P〈0.01;r550 nm=0.455,P〈0.01）,H组和M组分别与良性胃炎组比较,其荧光强度均存在显著差异（均P〈0.05）。而L组荧光强度只在450~500 nm波段内与良性胃炎组存在显著差异（P〈0.05）。讨论：波长450~500 nm有可能是检测低分化胃癌的自发荧光采集波段,可为提高自发荧光诊断胃癌的准确率提供参考。Objective To investigate the correlation of autofluorescence spectrum of gastric cancer with degree of differentiation for improving the diagnostic accuracy of gastric cancer by autofluorescence spectroscopy. Methods Eightyeight patients from Jan. to Dec. 2010 were recruited. Seventy-three patients were diagnosed as gastric cancer and 15 as chronic atrophic gastritis by endoscopy. Patients were examined with white-light endoscopy and laser induced autofluorescence spectrum. The data of autofluorescence spectrum were sampled in wavelength range of 400-700 nm at an interval of50 nm. Biopsies were taken from both lesions and adjacent healthy mucosa for histopathological examination. Surgical treatment was performed in patients with the diagnosis of gastric cancer. The cases of cancer were categorized according to degree of differentiation. The autofluorescence spectrum was compared between gastric cancer with different degree of differentiation and chronic gastritis. Results Seventy-three gastric cancer patients were classified into 3 groups according to degree of differentiation, 32 were in group H with well differentiated carcinoma, 16 in group M with moderately differentiated carcinoma, and 25 in group L with poorly differentiated carcinoma. Fifteen patients were cases with chronic atrophy gastritis. For wavelength 450-550 nm, fluorescence intensity had positive correlation with degree of differentiation（r450 nm=0.653, P〈0.01, r500 nm=0.712, P〈0.01, r550 nm=0.455, P〈0.01）. Fluorescence intensity of group H and group M was significantly different with that of chronic atrophic gastritis group at wavelength 400-550 nm. However, significant difference between group L and chronic atrophic gastritis group existed only at wavelength of 450-500 nm. Conclusions Fluorescence intensity at wavelength 450-500 nm is a promising method for detecting poorly differentiated gastric cancer, and may increase the diagnosis accuracy by laser induced autofluorescence spectrum.

关 键 词：自发荧光光谱 癌症分化程度 胃癌 

分 类 号：R735.2[医药卫生—肿瘤]