胃癌及癌前病变中的细胞凋亡与Bcl-2蛋白、P糖蛋白的表达及相关性研究

目的：探讨胃癌及癌前病变中细胞凋亡及Bcl-2蛋白与P糖蛋白（P－glycoprotein,P-gp)表达的变化规律及相互关系。方法：采用末端脱氧核苷酸转移酶（TdT)介导的dUTP缺口原位末端标记法（TUNEL）与免疫组织化学S－P法，分别检测细胞凋亡指数（Apoptotic Index,AI)及Bcl-2蛋白和P糖蛋白的表达。结果：AI和Bcl-2蛋白，P－gp的表达在30例慢性浅表性胃炎（CSG），11例慢性萎缩性胃炎（CAG），12例重度肠上皮化生（IM）三种吵的比较差异无显著性（P＞0．05），而在12例IM，13例中重度不典型增生（Dys),32例胃癌（GC）三组中的比较差异有显著性（P＜0．05），AI依次减少，Bcl-2蛋白与P－糖蛋白表达依次增加，AI与Bcl-2蛋白，P糖蛋白表达呈负相关（P＜0．05），Bcl-2蛋白与P糖蛋白呈正相关（P＜0．05），结论：癌前病变转化为胃癌与细胞凋亡与Bcl-2蛋白，P－gp的表达变化有关，同时P－gp,Bcl-2蛋白具有抗凋亡，耐药的双重作用，P－gp与Bcl-2蛋白可能存在协同作用。

Expression and Relationship of Apoptosis,Bcl-2 Protein and P-glycoprotein in Gastric Carcinoma and Precancerous Lesions

Objective: To study the expression and relationship of apoptosis, Bcl-2 protein and P-glycoprotein in gastric carcinoma and precancerous lesions. Methods:With terminal deoxynucleotidyl transferase mediated dUTP-biotin nick end labelling (TUNEL) technique, the cells apoptotic indexes (AI) were examined; With histochemistry and immunohistochemistry S-P methods, the expression of Bcl-2 protein and P-gp was examined. Results:There was no statistical difference of expression of AI, Bcl-2 protein and P-gp in the groups of 30 cases of chronic active supperticial gastritis (CSG), 11 cases of chronic atrophic gastritis(CAG) and 12 cases of intestinal metaplasia(IM) .However, statistical differences of expression of AI, Bcl-2 protein and P-gp were found in the groups of 12 cases of IM, 13 cases of gastric dysplasia(Dys) and 32 cases of gastric carcinomas(GC);AI were decreased, Bcl-2 protein and P-gp were increased continuously (P<0.05). AI were showed negative correlation with Bcl-2 protein or P-gp(P<0.05), and Bcl-2 protein was showed positive correlation with P-gp in gastric carcinoma occurring (P<0.05).Conclusions:The transformation of precancerous lesions to gastric carcinoma have relations with the cell apoptosis of gastric carcinoma and changes in the expression of Bcl-2 protein and P-gp ; Moreover, P-gp and Bcl-2 protein play dual roles in both anti-apoptosis and drug-resistance .There may be cooperative effects between P-gp and Bcl-2 protein.