食管癌高发区居民食管和贲门上皮细胞增生的测定

目的通过测定细胞增生核抗原（ＰＣＮＡ），Ｋｉ６７和溴脱氧尿嘧啶核苷（ＢｕｄＲ），进一步判断食管和贲门正常和各级病变上皮细胞增生状况，并对三种指标进行比较。方法采用ＢｕｄＲ渗入和免疫组化方法对辉县居民１７５例食管活检组织和４５例贲门活检组织进行ＰＣＮＡ，Ｋｉ６７和ＢｕｄＲ测定。并定量分析活检组织每平方毫米内免疫阳性细胞数。结果在正常和不同级别病变上皮均出现不同程度的ＰＣＮＡ，Ｋｉ６７和ＢｕｄＲ阳性细胞。在食管组织，随病变从正常到增生和间变，ＰＣＮＡ和Ｋｉ６７阳性细胞明显升高，比ＢｕｄＲ在同级病变升高３倍；在贲门组织，Ｋｉ６７阳性细胞数在正常上皮最低，随病变发展而升高。结论ＰＣＮＡ和Ｋｉ６７免疫类型与食管和贲门病变发展关系密切。这些指标将有助于检测食管和贲门癌高危人群，以及Ⅱ级预防效果的评价。ＰＣＮＡ比较容易测量，可能是食管癌研究有效的指标。     

慢性糜烂性胃炎的临床病理学及免疫组织化学研究

目的观察慢性糜烂性胃炎（ＣＥＧ）的临床病理特征及粘膜上皮的ｐ２１，ＣＥＡ表达和上皮细胞增生活性．结合粘膜Ｇ细胞数，探讨胃粘膜泌酸状态与病变的关系．方法ＣＥＧ４０例粘膜活检材料经光镜观察其组织病理学特征及Ｈｐ的感染．对其中３１例采用免疫组化ＬＳＡＢ法标记ｐ２１，ＰＣＮＡ，ＣＥＡ及胃泌素．结果ＣＥＧ病变８７５％（３５／４０）见于胃窦粘膜，７５％伴有不同程度的萎缩改变．粘膜上皮轻中度不典型增生率为２００％（８／４０），肠化率为２７５％，２５０％伴活动性炎；４００％病例可见Ｈｐ感染．ＣＥＧ粘膜上皮ｐ２１表达阳性率为６７７％，ＣＥＡ表达为２９０％；明显高于对照的慢性浅表性胃炎组．ＰＣＮＡ表达以及Ｇ细胞数目，ＣＥＧ组与对照组无显著差异（Ｐ＞００５）．结论ＣＥＧ具有一定恶性转化趋势，胃窦Ｇ细胞数、泌酸状态与ＣＥＧ的发病无明显关联．     

萎缩性胃炎中P53和PCNA的表达

目的了解Ｐ５３，ＰＣＮＡ在胃粘膜癌前病变中的表达意义．方法慢性萎缩性胃炎（ＣＡＧ）８９例，慢性浅表性胃炎（ＣＳＧ）２０例和胃腺癌２０例，作ＳＰ法观察Ｐ５３和ＰＣＮＡ的表达．结果Ｐ５３在ＣＳＧ和ＣＡＧ的单纯型、增生型和肠化型中不表达，异型性型中阳性表达率为１９０％（４／２１）．ＰＣＮＡ在ＣＳＧ和ＣＡＧ的单纯型、增生型、肠化型中无显著性差异（Ｐ＞００５）；而ＣＡＧ的异型性阳性细胞明显增多（Ｐ＞００１）．结论Ｐ５３表达与胃粘膜向癌的演变有关．ＰＣＮＡ随细胞增生活跃程度递增．二者结合对胃癌前病变的诊断、分级、治疗、预后有辅助价值．     

食管癌p16基因缺失分析

目的观察抑癌基因ｐ１６在不同病程食管癌患者癌组织中的缺失情况．方法采用ＰＣＲ方法检测２６例食管癌患者癌组织标本及邻近正常食管上皮组织标本ｐ１６基因的缺失情况．结果在２６例食管癌组织中检出１４例标本有ｐ１６基因第２外显子缺失，缺失率５３８％，而癌旁正常食管组织均无缺失．在Ⅱ期至Ⅳ期食管癌（Ｔ２Ｎ０Ｍ０至Ｔ４Ｎ１Ｍ１）均检测到ｐ１６基因缺失．结论ｐ１６基因缺失可能在食管癌发生及发展中起较重要作用     

表皮生长因子受体和PCNA在食管癌及癌前病变组织中的表达意义

目的探讨ＥＧＦＲ及ＰＣＮＡ的表达在食管癌发生发展过程中的临床意义．方法采用免疫组化ＳＰ法对各级食管鳞癌（Ⅰ级ｎ＝１８，Ⅱ级ｎ＝３０，Ⅲ级ｎ＝２２）、各级不典型增生（轻度ｎ＝１４，中度ｎ＝１７，重度ｎ＝１３）及正常食管粘膜（ｎ＝２０）进行ＥＧＦＲ及ＰＣＮＡ检测．结果ＥＧＦＲ及ＰＣＮＡ阳性表达在各组食管病变中呈明显递增趋势，正常组、轻度及中度不典型增生组间ＥＧＦＲ及ＰＣＮＡ表达均有显著性差异，ＥＧＦＲ阳性表达分别为：０／２０，３／１４及１０／１７；ＰＣＮＡⅠ，Ⅱ，Ⅲ，Ⅳ级表达分别为：１９／２０，１／２０，０／２０，０／２０；７／１４，６／１４，１／１４，０／１４；２／１７，７／１７，７／１７，１／１７（Ｐ＜００５）．鳞癌Ⅰ，Ⅱ级组间ＰＣＮＡ表达有显著性差异，ＰＣＮＡⅠ，Ⅱ，Ⅲ，Ⅳ级表达分别为１／１８，７／１８，８／１８，２／１８；２／３０，５／３０，８／３０，１５／３０（Ｐ＜００５）；而中、重度不典型增生与Ⅰ级鳞癌组间均无显著性差异（Ｐ＞００５）．结论食管中重度不典型增生者，其基因表达及增殖特性已具有明显的潜在恶性趋势，与食管癌的发生有直接关系，临床应对这类病例积极治疗并密切随访，以防癌变     

胃癌组织P53蛋白和PCNA的表达意义

目的研究胃癌组织Ｐ５３蛋白和增殖细胞核抗原（ＰＣＮＡ）的表达意义．方法应用ＡＢＣ免疫组织化学技术检测７６例保存资料完整并经病理学证实的胃癌石蜡包埋组织和３０例正常胃粘膜Ｐ５３蛋白及ＰＣＮＡ的表达进行同步检测．结果正常胃粘膜无Ｐ５３蛋白表达，而６４４％（４９／７６）胃癌组织中Ｐ５３蛋白表达阳性，Ｐ５３蛋白表达阳性者其细胞增殖活性为８２１％±１７６％，明显高于Ｐ５３蛋白表达阴性组的６４２％±１４３％（Ｐ＜００１）．Ｐ５３蛋白阳性率和ＰＣＮＡ计数值与胃癌临床分期及复发呈正相关（Ｐ＜００１）．结论联合检测Ｐ５３蛋白和ＰＣＮＡ对胃癌诊断、分期及预后有重要价值．     

食管癌高发区Barrett食管检出率和P_(53)的表达

了解食管癌高发区Ｂａｒｒｅｔｔ＇ｓ食管（ＢＥ）的患病率及ＢＥ与食管腺癌的关系。对３３１例河南省食管癌高发区农村自然人群进行了Ｂａｒｒｅｔ＇ｓ食管的内镜普查和病理组织学检查。同时对１４例来自门诊的Ｂａｒｒｅｔｔ＇ｓ食管病人的活检标本，用免疫组织化学染色的方法检测了抗癌基因Ｐ５３的表达。结果显示：该人群Ｅａｒｒｅｔｔ＇ｓ食管患病率为０．９１％，返流性食管炎的检出率为７．６％。抗癌基因Ｐ５３在１４例Ｂａｒｒｅｔｔ＇ｓ食管标本中阳性表达率为４２％。其中５０％阳性表达的标本伴有不典型增生。Ｐ５３阳性表达可能是Ｂａｒｒｅｔｔ＇ｓ食管上皮到食管腺癌发生过程中一个极早期的改变。对Ｂａｒｒｅｔｔ＇ｓ食管伴有不典型增生或肿瘤基因表达阳性者应视为高危人群，对他们进行重点预防和阻断治疗是必要的。     

青老年人胃癌P53及增殖细胞核抗原表达的对比

目的通过对老人青年胃癌中ｐ５３及增殖细胞核抗原（ＰＣＮＡ）表达的研究，探讨青老年人胃癌临床表现的分子生物学异同．方法应用过氧化物酶标记的链霉卵白素（ＳＰ）染色法对６５例胃癌（青年组３５例，≤３５岁；老年组３０例，≥６０岁）进行ｐ５３蛋白及ＰＣＮＡ的免疫组织化学染色．并对胃癌细胞中ＰＣＮＡ阳性颗粒进行图象分析．结果ｐ５３和ＰＣＮＡ在青年人胃癌中的阳性率分别为６５７％和９４３％，均显著高于老年人（２６７％和５００％，Ｐ＜００１）．青年人胃癌中ＰＣＮＡ阳性颗粒平均光密度及积分光密度均显著高于老年人（Ｐ＜００５）．结论ｐ５３及ＰＣＮＡ的高表达可能是青年人胃癌恶性度高，进展快，预后差的原因     

P^53蛋白,增殖细胞核抗原及胎盘型谷胱甘肽S—转移酶在胃癌 …

目的：研究胃癌中Ｐ＾５３，ＰＣＮＡ和ＧＳＴπ表达及意义，方法：应用免疫组织化学Ｓ－Ｐ方法检测５例正常胃组织和５４例胃癌组织中的Ｐ＾５３蛋白，增殖细胞核抗原（ＰＣＮＡ）和胎盘型谷胱甘肽Ｓ－转移酶（ＧＳＴπ）的表达水平。结果：５例正常组织中未见Ｐ＾５３ＰＣＮＡ和ＧＳＴπ表达。５４例胃癌组织中Ｐ＾５３，ＰＣＮＡ和ＧＳＴπ阳性检出率分别为６１．１１％，７０．３７％和６８．５２％，表达阳性Ｐ＾５３和ＰＣＮＡ     

食管癌高发区Barrett食管检出率和P53的表达

了解食管癌高发区Ｂａｒｒｅｔｔ＇ｓ食管（ＢＥ）的患病率及ＢＥ与食管腺癌的关系。对３３１例河南省食管癌高发区农村自然人群进行了Ｂａｒｒｅｔ＇ｓ食管的内镜普查和病理组织学检查。同时对１４例来自门诊的Ｂａｒｒｅｔｔ＇ｓ食管病人的活检标本，用免疫组织化学染色的方法检测了抗癌基因Ｐ_（５３）的表达。结果显示：该人群Ｂａｒｒｅｔｔ＇ｓ食管患病率为０．９１％，返流性食管炎的检出率为７．６％。抗癌基因Ｐ_（５３）在１４例Ｂａｒｒｅｔｔ＇ｓ食管标本中阳性表达率为４２％。其中５０％阳性表达的标本伴有不典型增生。Ｐ_（５３）阳性表达可能是Ｂａｒｒｅｔｔ＇ｓ食管上皮到食管腺癌发生过程中一个极早期的改变。对Ｂａｒｒｅｔｔ＇ｓ食管伴有不典型增生或肿瘤基因表达阳性者应视为高危人群，对他们进行重点预防和阻断治疗是必要的。     

食管贲门癌冷冻对免疫功能的调节

目的研究食管贲门癌患者食管腔内冷冻对免疫功能的调节作用．方法食管癌１５例，贲门癌５例；男１１例，女９例．先行食管腔内冷冻，再行开胸手术切除。用光镜及电镜系统观察癌细胞变化及局部淋巴反应，以及血中免疫球蛋白、补体Ｃ３及淋巴细胞转化试验ＬＴＴ．结果食管贲门癌原发灶周围淋巴结呈广泛性肿大，癌细胞坏死，可见异物巨细胞吞噬癌细胞，淋巴结呈滤泡增生反应．冷冻前后免疫球蛋白ＩｇＧ、ＩｇＭ无明显差异；ＬＴＴ由冷冻前的３８０％增加到４４８％，ＩｇＡ由冷冻前的２１６ｇ／Ｌ增加到２３２ｇ／Ｌ，Ｃ３也由冷冻前１３ｇ／Ｌ增加到２０ｇ／Ｌ．结论食管贲门癌腔内冷冻能调节机体的免疫功能和杀伤癌细胞．     

Alterations in p53 expression and cell proliferation in esophageal epithelia among patients from geographical areas with high or low incidence of esophageal cancer

AIM: To study changes in p53 expression and cell proliferation in esophageal epithelia of subjects from high or low esophageal cancer incidence areas in Henan Province to understand their molecular basis.METHODS: Esophageal endoscopic mucosa biopsies were acquired and histopathological examinations were performed on 220 subjects from high esophageal cancer incidence areas and 50 subjects from low incidence areas in Henan Province. Esophageal epithelia were diagnosed as normal, basal cell hyperplasia or dysplasia based on cell morphology and tissue structure. Immunohistochemistry avidin biotin peroxidase complex (ABC method) was performed to analyze alterations in p53 and proliferating cell nuclear antigen (PCNA) expression in normal epithelia and epithelia with different lesion severities. The numbers of p53-positive and PCNA-positive cells were counted.RESULTS: p53- and PCNA-positive nuclei were present in esophageal epithelia from subjects from both high and low incidence areas. The number of PCNA-positive cells gradually increased with lesion severity for both the high and low incidence areas. The number of p53-positive cells was higher in high incidence areas compared to low incidence areas, and rapidly increased with lesion severity. p53 expression positively correlated with PCNA expression.CONCLUSION: The number of both p53- and PCNA-positive cells increased with lesion severity. p53 expression was higher in subjects from high esophageal cancer incidence areas compared to those from low incidence areas. These results may shed light into the molecular basis for the geographical distribution of esophageal cancer.     

血管内皮生长因子表达与食管鳞癌临床病理的关系

目的 了解食管鳞癌组织中血管内皮生长因子（VEGF）的变化及其与临床病理的关系。方法 采用ABC方法测定食管鳞癌高发区74例食管鳞癌组织中VEGF蛋白的表达。结果 74例食管鳞癌组织中VEGF阳性表达为60.8%（45/74例）,VEGF阳性表达与食管鳞癌组织中肿瘤细胞增殖、浸润和淋巴结转移有相关性。VEGF在食管鳞癌中的表达存在有异质性。结论 VEGF蛋白在食管鳞癌的增殖、浸润和转移过程中起重要作用。     

Differential clinical and pathological characteristics of esophageal stromal tumors and leiomyomata

The objective of the study was to assess the differences in clinical and pathological characteristics between esophageal stromal tumor and leiomyoma. Data from 93 esophageal stromal tumors and leiomyomata cases were retrospectively analyzed, including clinical symptoms, endoscopic features, pathological characteristics, immunohistochemistry (IHC), and treatment. All cases underwent endoscopic ultrasonography examination before treatment. Lesions arising from the muscularis mucosa were resected by endoscopic mucosal resection or endoscopic submucosal dissection. Lesions arising from the muscularis propria were resected by surgery. All specimens were examined by IHC. Patients were followed up after endoscopic mucosal resection or endoscopic submucosal dissection. No difference was observed in clinical symptoms and endoscopic features between the two groups. Endoscopic ultrasonography demonstrated all lesions to be hypoechoic and well circumscribed. Most lesions >2 cm had heterogeneous internal ultrasound signal. In esophageal stromal tumor, 100% (29/29) were CD117‐positive and DOG‐1‐positive; 72.4% (21/29) and 51.7% (15/29) were CD34‐positive and smooth muscle actin‐positive, respectively. In esophageal leiomyomata, 100% (64/64) were smooth muscle actin‐positive and desmin‐positive; 100% were CD117‐negative and DOG‐1‐negative. No local recurrence was detected in followed up patients (n = 49) after an average of 1.8 years (1.0–3.0 years). IHC analyses are important for distinguishing esophageal stromal tumor from leiomyoma. Early endoscopic resection is an effective treatment option for esophageal stromal tumors >1 cm.     

Comparative studies on epithelial lesions at gastric cardia and pyloric antrum in subjects from a high incidence area for esophageal cancer in Henan, China

AIM To investigate the pathogenesis of gastric cardia and the distal part of stomach cancer and to further characterize the histopathogenesis model for gastric cardia cancer from the high-risk population for esophageal cancer.METHODS Mass survey with endoscopic mucosa biopsy and histopathological examination were carried out on 226 subjects aged above 30 years. Three biopsies were collected one each from the middle part of the esophagus, the gastric cardia and the pyloric antrum. The biopsy tissue was fixed with 85% alcohol and paraffin-embedded.RESULTS The incidence of intestinal metaplasia and dysplasia at gastric cardia epithelium was higher than that at the pyloric antrum from the subjects in the same area. And there were high incidences of both esophageal and gastric cardia cancer, but a low incidence of gastric cancer at the distal part of the stomach.CONCLUSION There might be different etiology and pathogenesis of gastric cardia and pyloric cancer at the distal part of the stomach.     

Original article: Prospective evaluation of narrow‐band imaging endoscopy for screening of esophageal squamous mucosal high‐grade neoplasia in experienced and less experienced endoscopists

Narrow‐band imaging (NBI) is a novel, noninvasive optical technique that uses reflected light to visualize the organ surface. However, few prospective studies that examine the efficacy of NBI screening for esophageal cancer have been reported. To compare the diagnostic yield of NBI endoscopy for screening of squamous mucosal high‐grade neoplasia of the esophagus between experienced and less experienced endoscopists. Patients with a history of esophageal neoplasia or head and neck cancer received NBI endoscopic screening for esophageal neoplasia followed by chromoendoscopy using iodine staining. Biopsy specimens were taken from iodine‐unstained lesions and the histological results of mucosal high‐grade neoplasias served as the reference standard. The primary outcome was the sensitivity of NBI for detecting new lesions. The secondary outcome was the positive predictive value of NBI and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of NBI in a per lesion basis. A total of 350 patients (170 by experienced endoscopists and 180 by less experienced endoscopists) underwent endoscopic examination. A total of 42 new mucosal high‐grade neoplastic lesions (25 in the experienced endoscopist group and 17 in the less experienced endoscopist group) were detected. In the per‐lesion‐based analysis, the sensitivity was significantly higher in the experienced endoscopist group (100%; 25/25) compared with the less experienced endoscopist group (53%; 9/17) (P < 0.001). The positive predictive value of NBI was higher in the experienced endoscopist group than in the less experienced endoscopist group (45%, 25/55 vs. 35%, 9/26), although the difference was not significant (P = 0.50). The sensitivity of NBI in the less experienced endoscopist group was 43% in the former half of patients, and increased to 60% in the latter half of patients. In the per‐patient‐based analysis, the sensitivity of NBI was significantly higher in the experienced endoscopist group (100%) than in the less experienced endoscopist group (100 vs. 69%, respectively; P = 0.04). The positive predictive values of the experienced endoscopist group and the less experienced endoscopist group were similar, and were 48 and 47%, respectively. In conclusion, compared with the gold standard of chromoendoscopy with iodine staining, the sensitivity of NBI for screening of mucosal high‐grade neoplasia was 100% with the experienced endoscopists but was low with the less experienced endoscopists. Electronic chromoendoscopy with NBI is a promising screening tool in these high‐risk patients with esophageal mucosal high‐grade neoplasia, particularly when performed by endoscopists with experience of using NBI.     

高龄低肺功能食管癌患者手术治疗的研究

目的 :探讨高龄低肺功能食管癌病人外科手术治疗适应症、手术方式的选择及术后呼吸机的应用。方法 :4 6例 70岁以上食管癌患者依据最大通气量占预计值百分比 (MVV ,% )分为 2组 :第一组 ,MVV≤ 5 0 % 2 2例 ,第二组为对照组 :MVV >5 0 % 2 4例 ;第一组再分 2组 :1组MVV <4 0 % 3例 ,其中 2例术前FEV1 FVC <4 5 % ,1例FEV1 FVC >4 5 % ;2组 :MVV 4 0 %～ 5 0 % 19例 ,FEV1 FVC均 >4 5 %。第一组患者术后均使用呼吸机辅助呼吸。对比研究 1组、2组患者及对照组呼吸衰竭、心律失常发生情况。结果 :各组无手术死亡 ;1组中 2例 (FEV1 FVC <4 5 % )同时发生呼吸衰竭及心房颤动 ;2组中 4例病人出现心律失常 ,无呼吸衰竭 ;对照组中 5例病人出现心律失常 ,无呼吸衰竭。结论 :由于手术技术提高和术后呼吸机的应用 ,可相对扩大手术适应征     

Human papillomavirus 16 E6 is associated with the nuclear matrix of esophageal carcinoma cells

AIM:To explore the etiologic role of HPV infection inesophageal carcinoma,and the association of HPV-16 E6with the nuclear matrix of carcinoma cells.METHODS:Two esophageal carcinoma cell lines,EC/CUHK1 and EC/CUHK2,were tested for HPV-16 E6subgenetic fragment by polymerase chain reactionarnplification of virus DNA associated nuclear matrix.RT-PCR and immunocytochemistry were also used to visualizethe expression of E6 subgene in the cells.RESULTS:The HPV-16 E6 subgenetic fragment was found tobe present in nuclear matrix-associated DNA,E6oncowprotein localized in the nucleus where it is tightlyassociated with nuclear matrix after sequential extraction inEC/CUHK2 cells.It was not detected,however,in EC/CUHK1 cells.CONCLUSION:The interaction between HPV-16 E6 andnuclear matrix may contribute to the virus inducedcarcinogenesis in esophageal carcinoma.     

Comparative studies on epithelial lesions at gastric cardia and pyloric antrum in subjects from a high incidence area for esophageal cancer in Henan, China

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