锯齿状息肉病综合征的研究进展  

Research progress of serrated polyposis syndrome

作　　者：董世濠 陈劲松[1] 

机构地区：[1]广州医科大学附属第一医院胃肠外科,510120

出　　处：《中华胃肠外科杂志》2016年第10期1197-1200,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金项目（81572424）;广州市科技计划项目（201607010164）

摘　　要：锯齿状息肉病综合征（SPS）与结直肠癌的发生发展密切相关，但目前国内学者对SPS的研究不多。锯齿状息肉分为增生性息肉（HP）、无蒂锯齿状息肉（SSA）和传统锯齿状息肉（TSA）。SPS诊断标准为（1）在近端结肠中发现至少有5个锯齿状病变，并且〉2个锯齿状息肉直径〉10mm；（2）患者有SPS家族史，且发现1个结直肠锯齿状息肉；（3）在整个结直肠肠腔中发现〉20个锯齿状息肉。SPS发展为结直肠癌的风险较高．25％～70％的SPS患者在诊断的同时或随访期间诊断为结直肠癌。SPS具有发病年龄较晚、发病率无明显种族差异、有结直肠癌的家族史等临床特征；多存在BRAF基因或KRAS基因突变，通过激活RAS—RAF—MAPK通路致病，也存在CpG岛甲基化表型（CIMP）和微卫星不稳定表型（MSI）。临床上SPS需注意与传统的家族性腺瘤息肉病（FAP）区别，SPS的发病机制、临床特点和癌变风险均与其不同。目前常用的锯齿状息肉的检测技术的是自体荧光显像（AFI）和窄带成像内镜（NBI），检出率均在55％左右。建议患有SPS的患者应尽可能切除所有直径超过3～5mm的息肉，且每1-2年行全结直肠内镜检查。目前对SPS的研究仍处于起始的阶段，关于其具体分子机制尚未完全清楚，对SPS发展为结直肠癌的具体风险也未达到共识，有待更深一步研究。Serrated polyposis syndrome （SPS） is closely associated with the initiation and development of colorectal cancer （CRC）, however, there is few research on SPS in China. Serrated polyps can be divided into hyperplastic polyps, sessile serrated polyps and traditional serrated polyps.The diagnosis standard of SPS is as following： （1） There are at least 5 serrated lesions in proximal colon, and diameter of more than 2 lesions is 〉 10 mm; （2） The patient has one serrated polyp with family history of SPS; （3） More than 20 serrated polyps can be found in the entire large bowel. The risk of SPS is relatively high in the development of colorectal cancer and 25%-70% of the SPS patients is diagnosed with synchronous or metachronous colorectal cancer during following-up. The clinical characteristics of SPS include that patients are relatively old; no significant racial difference exists in the morbidity; patients have family history of colorectal cancer. The mutation of BRAF or KRAS gene, which induces eolorectal cancer through the RAS-RAF-MAPK signaling pathway, is often found in SPS as well as CpG island methylation phenotype （CIMP） and microsatellite instability （MSI）. The difference between SPS and traditional familial adenomatous polyposis （FAP） should be noted because of the different pathology mechanism, clinical characteristics and the risk of malignancy. Nowadays, the common technologies of detecting serrated polyps are autofluorescence imaging （AFI） and narrow-band imaging （NBI）, whose detective rate is around 55%. The SPS patients are advised to undergo the resection of all the serrated polyps with diameter larger than 3-5 mm and receive the eolonoscopy examination every 1 or 2 year. Not only the research about SPS is on the initiation step and the molecular mechanism is still unknown, but also the scholars do not come to achieve agreement about the risk of SPS in the malignancy of colorectal cancer, which is essential for further research therefore.

关 键 词：息肉 锯齿状 结直肠肿瘤 综述 

分 类 号：R735.34[医药卫生—肿瘤]