细胞凋亡及相关基因联合检测对胃黏膜癌前病变的诊断及癌变预测的意义

目的探讨细胞凋亡及相关基因的表达在胃黏膜癌变中的作用及对胃癌的预测和早期诊断的意义。方法对胃镜活检确诊为胃癌（胃癌组）及不典型增生（分为轻、中、重度不典型增生组）的标本应用TUNEL法检测细胞凋亡，应用免疫组化法检测p16、bcl-2、raa、c—myc、p53基因的表达。结果p16、bcl-2、ras、c-myc和p53基因表达率在轻、中、重度不典型增生组和胃癌组分别为69．23％，30．77％，38．46％，23．08％，7．69％；50．00％，37．50％，81．25％，43．75％，18．75％：36．36％．63．64％．81．82％．72．73％，45．45％：27．50％，67．50％，95．00％。90．00％，60．00％。轻度不典型增生组与胃癌组比较，差异有统计学意义（P〈0．05）；ras、c—myc和p53基因表达率轻度不典型增生组与重度不典型增生组比较，差异有统计学意义（P〈0．05）；p53与c—myc基因表达率中度不典型增生组与胃癌组比较，差异有统计学意义（P〈0．05）。p16、bcl-2、ras、c—myc和p53基因表达存在相关性。细胞凋亡指数胃癌组最低，轻、中度不典型增生组与胃癌组比较，差异均有统计学意义（P〈0．01）。轻度不典型增生组与重度不典型增生组比较，差异也有统计学意义（P〈0．01）。结论细胞凋亡指数减少及ras、bcl-2、c—myc、p16、p53基因的异常表达在胃黏膜癌变过程中发挥重要作用。中、重度不典型增生为重要的癌前病变。

The significance of the early diagnosis and prediction of gastric carcinoma by detecting cell apoptosis and expression of correlative genes in precancerous lesion

Objective To discuss the effect and relationship of cell apoptosis and expression of correlative genes during the carcinogenesis process of gastric mucosa and the significance in the early diagnosis and prediction of gastric carcinoma.Methods Applying standard immunohistochemical techniques to detect p53,p16,bcl-2,ras and c-myc protein expression and TUNEL techniques to detect cell apoptosis in dysplasia(divided into mild,morderate,severe dysplasia group)and carcinoma(carcinoma group)mucosa through gastroendoscopy biopsied.Results The protein expression rates of p16,bcl-2,ras,c-myc and p53 in mild,morderate,severe dysplasia group and carcinoma group were 69.23%,30.77%,38.46%,23.08%,7.69%;50.00%,37.50%,81.25%,43.75%,18.75%;36.36%,63.64%,81.82%,72.73%,45.45%;27.50%,67.50%,95.00%,90.00%,60.00%.It had significant difference between mild dysplasia group and carcinoma group(P<0.05)and between severe dysplasia group and mild dysplasia group in ras,c-myc and p53 protein expression(P<0.05),it also had significant difference between moderate dysplasia group and carcinoma group in p53 and c-myc protein expression(P<0.05).There was significant correlation among p16,bcl-2,ras,c-myc and p53 protein expression.The apoptosis index was higher in dysplasia mucosa than that in carcinoma mucosa,it had significant difference among mild,moderate dysplasia and carcinoma(P<0.01),and so did between mild and severe dysplasia.Conclusion Inhibition of apoptosis and abnormality of correlative genes ras,bcl-2,c-myc,p16 and p53 play important roles in the progress of carcinogenesis of stomach.Moderate and severe dysplasia are important precancerous lesions.