阿辛蓝过碘酸雪夫染色和Ki-67表达在胃黏膜反应性增生与异型增生鉴别诊断中的价值  

The value of Alcian blue periodic acid Schiff staining and Ki-67 expression in diagnosing gastric reactive epithelial hyperplasia and dysplasia

作　　者：石中月 侯卫华 王莹[1] 田忠秋 曹勍[1] 郭昕萌 路军[1] 李雪[1] 陈红[1] 金木兰[1] Shi Zhongyue;Hou Weihua;Wang Ying;Tian Zhongqiu;Cao Qin;Guo Xinmeng;Lu Jun;Li Xue;Chen Hong;Jin Mulan(Department of Pathology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Pathology,People′s Liberation Army Joint Logistics Support Force 989 Hospital(formerly 152 Hospital),Pingdingshan 467099,China)

机构地区：[1]首都医科大学附属北京朝阳医院病理科,北京100020 [2]解放军联勤保障部队第九八九医院平顶山医疗区(原第一五二中心医院)病理科,平顶山467099

出　　处：《中华病理学杂志》2022年第8期713-718,共6页Chinese Journal of Pathology

摘　　要：目的:探讨胃黏膜反应性增生及异型增生的临床病理学特征以及黏蛋白特殊染色、增殖细胞核抗原(Ki-67)对于鉴别两种增生的临床应用价值。方法:收集首都医科大学附属北京朝阳医院2018年5月至2021年5月诊断的胃黏膜反应性增生63例、低级别异型增生54例、高级别异型增生63例患者临床病理资料,通过阿辛蓝过碘酸雪夫(AB-PAS)染色及Ki-67免疫组织化学染色观察3组病变的黏蛋白变化特点、Ki-67阳性细胞数及分布模式,并观察其组织形态学特点。结果:AB-PAS染色在胃黏膜反应性增生、异型增生中阳性率分别为87.3%(55/63)、10.3%(12/117),AB-PAS染色在胃黏膜反应性增生中表现为腺体底部到表层细胞质内AB-PAS阳性中性黏蛋白颗粒逐渐增多的成熟现象,低级别异型增生及高级别异性增生中表现为异型增生的腺体细胞质内AB-PAS阳性黏蛋白颗粒缺失的现象,两组比较差异有统计学意义(P<0.01)。Ki-67在胃黏膜反应性增生组中阳性表达率(>10%)为81.0%(51/63),阳性细胞主要位于腺颈部及黏膜中部(58/63,92.1%)。低级别异型增生组中阳性表达率(>10%)为90.7%(49/54),阳性细胞主要位于黏膜上部(33/54,61.1%),呈带状分布。高级别异型增生组中阳性表达率(>10%)为95.2%(60/63),阳性细胞主要位于黏膜全层(49/63,77.8%),呈弥漫/弥漫散在分布,3组比较Ki-67阳性表达数量及分布部位差异有统计学意义(P<0.01)。结论:AB-PAS染色、Ki-67免疫组织化学标记可为胃黏膜反应性增生及异型增生鉴别提供重要依据。Objective To investigate the clinicopathological characteristics of reactive epithelial hyperplasia and dysplasia in the stomach,as well as the clinical value of mucin special staining and proliferating cell nuclear antigen(Ki-67)in distinguishing the two gastric lesions.Methods The clinical pathological data of 63 patients with gastric reactive epithelial hyperplasia,54 patients with low-grade dysplasia,and 63 patients with high-grade dysplasia diagnosed from May 2018 to May 2021 in Beijing Chaoyang Hospital,Capital Medical University,Beijing,China were analyzed.Alcian blue periodic acid Schiff(AB-PAS)and Ki-67 staining were performed to examine the mucin staining pattern,number of Ki-67 positive cells,Ki-67 staining patterns in the three groups of lesions,and histopathologic characteristics.Results The positive rates of AB-PAS in the reactive epithelial hyperplasia and gastric dysplasia groups were 87.3%(55/63)and 10.3%(12/117),respectively.The expression of AB-PAS in the reactive epithelial hyperplasia was gradually increased from the base to the surface of the epithelium.In low-grade dysplasia and high-grade dysplasia,there was no mucin present in the dysplasia epithelium.The difference between the two groups was statistically significant(P<0.01).The positive rate of Ki-67 in the epithelial reactive hyperplasia(>10%)was 81.0%(51/63),and the positive cells were mainly located in the neck and middle parts of the mucosal glands(58/63,92.1%).In the low-grade dysplasia group,the positive rate of Ki-67(>10%)was 90.7%(49/54);the positive cells were mainly located in the upper mucosa(33/54,61.1%),showing a banded distribution pattern;in the high-grade dysplasia group,the positive rate(>10%)was 95.2%(60/63),and the positive cells were mainly located in the whole mucosa(49/63,77.8%),showing a diffuse/diffuse scattered distribution pattern.The three groups had statistically different rates and distribution patterns of Ki-67 expression(P<0.01).Conclusion The gastric epithelial reactive hyperplasia and dysplasia can be di

关 键 词：胃黏膜 增生 染色与标记 KI-67抗原 

分 类 号：R573[医药卫生—消化系统]