大肠扁平腺瘤与息肉样腺瘤的对比研究

大肠扁平腺瘤指平坦或轻微隆起于大肠黏膜表面的腺瘤，其腺瘤成分的厚度不超过周围正常黏膜的两倍，1985年由Muto等最早报道。多项研究显示，大肠扁平腺瘤占所有大肠腺瘤患者的12％～42％，伴重度异型增生的比例超过12％，远高于息肉样腺瘤的4％，故认为扁平腺瘤是易癌变的特殊腺瘤类型。本研究通过结肠镜检查、病理检查和免疫组化染色研究大肠扁平腺瘤的特点。     

大肠小的扁平腺瘤内镜和病理学研究

为着重研究大肠小的扁平瘤和非腺瘤性的早癌，本组１４６例大肠小的扁平隆起病变经病理活检进行内镜下形态和组织学对照研究。结果证实粘膜慢性炎１９例，炎性息肉６３例，增生性息肉３４例，小的扁平腺瘤２７例不含腺瘤成份的早癌３例。     

内镜黏膜切除术在大肠小扁平腺瘤中的临床应用

目的探讨内镜下黏膜切除术(EMR)在大肠小扁平腺瘤中的临床应用价值。方法选择89例114个内镜下直径≤10mm,圆形或椭圆形隆起性病灶,黏膜下生理盐水注射后非提起征阴性者行黏膜切除术,全瘤病灶送病理学检查;观察手术并发症并作相应处理。对腺瘤患者术后进行6～18月随访。结果114个大肠小扁平隆起性病变中,腺瘤21个,分布于大肠各个部位,其中,以直、乙状结肠多见;其他93个为增生性息肉或炎症性息肉。21个大肠小扁平腺瘤大多伴有上皮细胞不同程度异型增生,共中轻度13个(61.9%),中度4个(19.0%),重度2个(9.5%)。89例11个病灶EMR术中,3例发生即时出血,以病灶周边渗血为主,电凝后出血停止,2例分别在第3d、第6d发生一过性出血,均因过量运动所致,保守治疗后出血停止。21个腺瘤患者随访6～18月,原发灶部位均未见病变复发。结论内镜黏膜切除术对于大肠小扁平腺瘤不仅安全、有效,而且完全彻底,对早期大肠癌的防治具有重要的意义,值得临就床推广。     

内镜微波治疗大肠腺瘤性息肉

１９９２年５月至１９９７年５月,我们对１２８例大肠腺瘤性息肉患者共２１６个息肉行内镜微波治疗,疗效显著。１．一般资料：本组中男８６例,女４２例,年龄１８～７５岁,平均４９．６岁;共２１６个息肉,分布于直肠４５个,乙状结肠８２个,降结肠３６个,横结肠４１个,升结肠８个,盲肠４个;有蒂息肉１６１个,无蒂息肉５５个;其中单发性息肉８１例,多发性息肉４７例;息肉小于１．０ｃｍ者１８６个,１．１～２．０ｃｍ者２６个,大于２．０ｃｍ者４个所有病例均行内镜下活检,病理报告示腺瘤性息肉,并有２９例伴有异型增生Ⅰ…     

大肠远侧腺瘤者存在大肠近侧息肉的危险性

本文回顾性调查了：（１）大肠远侧腺瘤是否标志着同存大肠近侧息肉以及危险性；（２）随年龄增加是否有大肠腺瘤从左侧向右侧分布的右移倾向。结果：大肠镜检查并且病理诊断确切者３７４例，分成腺瘤２９７例，炎性息肉７７例。大肠远侧腺瘤的２６２例中，有６９例（２６．３％）同存大肠近侧腺瘤，大肠远侧炎性息肉的７０例中只有５例同存大肠近侧腺瘤（７．０％），二者相比有显著性差异（Ｐ＜０．０１）。故与炎性息肉相比，大肠远侧有腺瘤者同存大肠近侧腺瘤的危险性高６．４倍（９５％可信限２．５～１４．８）。脾曲以上有大肠腺瘤者（１０９例）与脾曲以上无腺瘤者（１９３例）相比，平均年龄大７岁（５７．８±１２．２比５１．７±１６．２，Ｐ＜０．０１），说明随年龄增加大肠腺瘤有右移倾向。     

大肠小扁平腺瘤的形态及病理组织学特征研究

目的探讨大肠小扁平腺瘤的形态学特征及p53、p21、雌激素受体（estrogen receptor，ER）、孕激素受体（progesterone receptor，PR）表达的生物学意义。方法用Olympus CF240型电子结肠镜及OlympusBX41光学显微镜观察50例大肠小扁平腺瘤形态学特征。用免疫组化二步法检测50例小扁平腺瘤及其腺瘤旁组织、26例大肠癌及其癌旁组织、15例正常人大肠黏膜中p53、p21、ER、PR的表达情况。结果小扁平腺瘤发生于大肠任何部位，其发病率依次以横结肠、乙状结肠、直肠为多见；肠镜下见病灶呈圆形或椭圆形，扁平状，基底宽，体积≤1cm。光镜下小扁平腺瘤呈管状腺瘤样图像，上皮具有不同程度的异型增生。小扁平腺瘤中p53、p21、ER、PR的表达率分别为58％（29／50）、56％（28／50）、12％（6／50）、10％（5／50）。随着小扁平腺瘤异型增生程度的增高，p53、p21、ER、PR的表达率也逐渐升高（P〈0．05）。大肠癌中的表达最高（P〈0．05）。结论大肠小扁平腺瘤有其独特的形态学特征，p53、p21、ER、PR的表达与大肠小扁平腺瘤的发生发展有密切关系。     

大肠腺瘤性息肉癌变因素的探讨——附245例分析

本文回顾性的总结分析了我院245例大肠腺瘤性息肉的内镜诊断和病理特点，旨在探讨大肠腺瘤癌变过程的相关因素，以提高大肠癌的早期诊断率。临床资料我院1978年～1996年间进行肠镜检查6807例，检出息肉629例，检出率9．24％。其中腺瘤性息肉245例，检出率3．60％。245例腺癌性息肉中，男167例，女78例。男女之比2．14：1。年龄8～81岁，平均44S岁。临床表现以便血或粘液血便为主，占53．88％（132例）。息肉分布：直肠102例（4。63％），乙状结肠79例（3．24％），降结肠19例（．76％），横结肠20例（．16％），升结肠及盲肠17例（．94％）…     

大肠息肉与胆囊息肉样病变的相关性

目的:探讨大肠息肉与胆囊息肉样病变(polypoid lesions of the gallbladder,PLG)的相关性.方法:随机选取我院行结肠镜检查的患者211例,分为大肠息肉组(n=111)和对照组(n=100),利用超声检查对大肠息肉组PLG的发生情况进行观察,并与对照组进行对比分析.结果:大肠息肉组PLG的发生率明显高于对照组(x2=13.60,P<0.001);男女性大肠息肉组间PLG的发生率无差异:按大肠息肉的病理类型进行分层比较显示非腺瘤性大肠息肉组PLG的发生率高于对照组(x2=3.86,P<0.05),而腺瘤性大肠息肉组PLG的发生率明显高于对照组(x2=19.04,P<0.001),且高于非腺瘤性大肠息肉组(x2=3.94,P<0.05).结论:大肠息肉与PLG之间可能存在一定的相关性.     

大肠锯齿状腺瘤7例报告

大肠的锯齿状腺瘤指大肠的一类特殊病理形态的腺瘤,其成瘤上皮成分有明显增生,使腺管或绒毛呈现锯齿状外观,类似于增生性息肉样改变,或腺瘤成分与增生性息肉成分同时存在。1990年Longacre TA报告了110例这种形态的腺瘤,并将其命名为混合型增生性腺瘤样息肉／Serrated腺瘤,后被简称为Serrated腺瘤即锯齿状腺瘤。     

大肠高风险腺瘤危险因素研究

目的 探究大肠高风险腺瘤的危险因素,为建立有效干预措施提供临床依据。方法 统计我院住院腺瘤性息肉患者676例,男438例,女238例,其中低风险腺瘤(低风险组)479例,男305例,女174例;高风险腺瘤(高风险组)197例,男133例,女64例。采集一般资料(性别、年龄、体质指数BMI、饮食、吸烟、饮酒、运动、大肠肿瘤一级亲属、大便情况),病史(血脂、脂肪肝、高血压、糖尿病、冠心病、胆囊切除、HP感染情况),结肠镜数据(息肉的数量、大小、部位),息肉病理等数据。比较高风险组与低风险组上述数据差异,采用多因素Logistic回归分析大肠高风险腺瘤独立危险因素。结果 高风险组与低风险组相比,两组在年龄、BMI值、大肠癌一级亲属、高脂血症、胆囊切除、HP感染、果蔬饮食方面存在差异(P<0.05)。将差异结果纳入多因素Logistic回归分析,发现高龄(≥50岁)、大肠癌一级亲属、高脂血症、胆囊切除、HP感染是高风险腺瘤发病的独立危险因素,而喜食果蔬类食物为其保护因素(P<0.05)。结论 高龄(≥50岁)、大肠癌一级亲属、高脂血症、胆囊切除、HP感染是高风险腺瘤发病的独立危险因...     

大肠平坦型腺瘤、隆起型腺瘤和腺癌的p53、c-myc和ki-67表达比较

目的 检测大肠平坦型腺瘤、隆起型腺瘤和浸润性大肠癌p53、c-myc和ki-67的表达水平,探讨其基因调控机制.方法 选取2002至2006年间行结肠镜检查并经病理证实的平坦型、隆起型腺瘤和腺癌的病变标本,用免疫组织化学二步法检测p53、c-myc和ki-67的表达水平,分析三者表达水平在各组病变的差异和意义.结果 p53、c-myc和ki-67在平坦型腺瘤、隆起型腺瘤和腺癌中阳性表达率分别为3.33%(1/30)、8.06%(5/62)和69.44%(25/35);33.33%(10/30)、58.06%(36/62)和80.56%(29/36);23.33%(7/30)、19.35%(12/62)和50.00%(18/36);在正常组织中均无明显表达.结论 平坦型腺瘤、隆起型腺瘤和大肠癌三者具有不同的p53、c-myc和ki-67表达,提示三者的发生、发展可能存在不同基因调控机制,平坦型腺瘤的癌发生途径可能与隆起型腺瘤不同.     

原发性肝细胞癌中P21WAF-1、p53与nm23的表达及意义

目的 探讨p21WAF-1、p53与nm23蛋白在原发性肝细胞癌（HCC）中的表达及意义。方法 应用免疫组化S-P法检测72例HCC和85例非癌肝组织中p21WAF-1、p53与nm23蛋白的表达，并分析它们之间的关系及其与HCC临床、病理特征的关系。结果 HCC组织中的p21WAF-1、p53与nm23蛋白表达率均与非癌组织有显著性差异（P〈0．01）。p21WAF-1及nm23在Ⅰ、Ⅱ期HCC中表达率与Ⅲ、Ⅳ期有明显差异。p53及nm23表达率在HCC无转移组与转移组有明显差异（P〈0．05，〈0．01）。结论 p21WAF-1、p53高表达，nm23低表达均在HCC的发生发展中起作用；联合检测p21WAF-1、p53与nm23蛋白指标有助于判断HCC患者预后。     

Immunohistochemical Expression of p16, p53, and p63 in Colorectal Adenomas and Adenocarcinomas

Purpose The aim of this study was to investigate the immunohistochemical expression of p16, p53, and p63 proteins according to some pathologic parameters related to colorectal adenomas and adenocarcinomas such as grade of dysplasia and histologic type. Methods Immunohistochemistry with the antibodies p16, p53, and p63 was performed in tubular, tubular-villous, and villous adenomas (n = 30) and in well, moderately, and poorly differentiated adenocarcinomas (n = 30). The p63-positive cases were submitted to double immunolabeling with the cytokeratin 5 (CK5). Results The p16 and p53 labelings were observed in some adenomas and adenocarcinomas but without any association with p63 expression, histologic type, or grade of differentiation of the neoplasm. P63 expression was found mainly in the villous adenomas and in the poorly differentiated adenocarcinomas. The poorly differentiated adenocarcinomas also exhibited coexpression of CK5 and p63. Conclusions Despite both p16 and p53 having been detected in colorectal neoplasms, they were not related to the different histologic variables nor to the expression of p63. However, p63 expression was closely associated with villous adenomas and poorly differentiated adenocarcinomas. Thus, p63 may represent a marker of poor differentiation in colorectal neoplasms. The coexpression of p63 and CK5 observed in this study could be related to divergent differentiation during the development of colorectal cancer, although further studies are warranted to refine the understanding of this process.     

Expression of p53 and p21 Are Independent Prognostic Factors in Patients with Serosal Invasion by Gastric Carcinoma

To evaluate whether the expression of p53 andthat of p21 are independent prognostic factors inpatients with advanced gastric cancer, we investigatedclinicopathological factors and the expression of p53 and p21 in 158 patients with gastric cancerthat had invaded the serosa and who had undergonecurative gastrectomy. In multivariate survival analysisof 156 surviving patients, we evaluated the size of the tumor, lymph node metastasis, venousinvasion, lymph node dissection, expression of p53, andexpression of p21 as independent prognostic factors.Moreover, we divided patients into four groups according to the expression of p53 and p21 in theirtumors [group A, p53^-/p21^-, N = 40(one died within 30 days of surgery); group B, p53^-/p21^-, N = 23; group C,p53⁺/p21⁺, N = 58; and group D,p53⁺/p21⁺, N = 37 (one died within 30 days of surgery)]. The 5- and 10-yearsurvival rates of 39 patients in group A were 71.7% and64.3%, those of 23 patients in group B were 81.4% and81.4%, those of 58 patients in group C were 35.6% and 30.2%, and those of 36 patients ingroup D were 67.9% and 60.7%. The prognosis of patientsin group C was poorer than that of patients in the otherthree groups. This result indicates that the evaluation of the expression of both p53 andp21 expression might provide prognostic information thatis more accurate than that provided by evaluation of theexpression of p53 alone.     

胃复春对胃癌癌前病变的治疗及对p21ras、p53表达的调节作用研究

目的：研究胃复春片对胃黏膜中、重度异型增生的治疗作用及对P21^ras、P53蛋白表达的调节作用，探讨其逆转胃癌癌前病变的治疗价值及机制。方法：内镜下病理活检证实为中、重度异型增生患者共58例，随机分为胃复春治疗组32例，维酶素对照组26例。治疗前后比较临床疗效，镜下改变，病理改变及胃黏膜固定部位活检标本P21^ras、P53蛋白S-P法免疫组化染色变化情况。结果：胃复春组临床症状的总有效率81．25％，内镜下改变总有效率71．88％，病理学改变总有效率65．63％，均优于维酶素对照组(分为53．85％、46．15％、34．61％)。P21^ras、P53蛋白在中、重度异型增生组织中有过度表达，胃复春能使其表达明显减弱。结论：胃复春对胃黏膜中、重度异型增生有良好的治疗作用，能促进病变胃黏膜的逆转，并对P21^ras、P53蛋白的表达有一定的调节作用，降低癌变危险性，可用于胃癌癌前病变的治疗。     

p53 and Follow-up of Colorectal Adenocarcinomas

Circulating p53 antibodies (ELISA method), p53genetic alterations (SSCP), and protein overexpression(immunohistochemistry) were studied in 41 patients withcolorectal adenocarcinomas and 10 control patients. Carcinoembryonic antigen (CEA) and carbohydrateantigen 19.9 (CA 19-9) were evaluated in parallel. Tenpatients with p53 antibodies and p53 overexpression wereselected. Tumor DNA extracts from these 10 patients were analyzed by SSCP. Of all 41patients, 10 (24%) showed significant levels of p53antibodies, and p53 accumulation was detected in 20(48%) patients. In six patients, p53 antibodieconcentrations decreased rapidly after surgery; in twopatients, these levels returned to normal values. Of the10 selected tumors, eight revealed TP53 gene mutations.Only two patients with high values of both CEA and CA 19-9 developed p53 antibodies. Inconclusion, beside classical tumor markers, circulatingp53 antibodies may be considered as additional markersfor the management of patients with colorectaladenocarcinomas.     

食管内反流物成分与p53、细胞周期素D1、p21、p16表达的相关性研究

目的 研究胃及十二指肠液食管反流对食管内抑癌基因、癌基因表达的影响及与黏膜损伤的关系。方法 制作单纯胃食管反流（G组）、单纯十二指肠食管反流（D组）、十二指肠胃混合食管反流（DG组）及无反流对照组（C组）动物模型,用免疫组化法（SABC）检测各组不同时期食管上皮P53、细胞周期素D1（Cyclin D1）、p21、p16等基因的表达。结果 反流组食管组织中p53、CyclinD1基因表达均显著高于C组,并随病程延长而明显增强,D组表达又强于G组;各组不同时期p16表达无明显差异;p21表达在D组、DG组较C组为低,且与p53蛋白表达呈负相关。结论 食管内胃及十二指肠反流物均可改变食管上皮p53、Cyclin、p21基因的表达,十二指肠内容物的作用更明显。但反流对p16基因的表达影响不大。p53、CyclinD1、p21等癌基因或抑癌基因的表达改变可能参与反流性食管炎及其并发症的发生。     

p16、p53、p21基因对肺癌细胞增殖的影响

目的 观察肿瘤抑制基因ｐ１６,ｐ５３及细胞周期信赖激酶抑制物ｐ２１基因单独或联合应用时对肺癌细胞增殖的影响。方法 应用十八酰基胺阳离子脂质体介导ｐ１６,ｐ５３,ｐ２１基因单独或共转染到非小细胞肺癌细胞系Ａ５４９和小细胞肺癌细胞系ＳＨ７７,观察转染后１,３,５日该细胞增殖的活力。采用四甲基偶氮唑 盐微量酶反应比色法（ＭＴＴ法）测定吸光度（Ａ）,以检测细胞增殖活力,结果 Ａ５４９细胞系：Ａ均值分别为：     

Gene and protein expression of p53 and p21 in fibroadenomas and adjacent normal mammary tissue

The aim of this study was to compare p53 and p21 mRNA, and proteins levels between fibroadenomas and adjacent normal mammary tissue of women in reproductive age. A transversal study was performed. Fourteen patients who attended the Breast Service of the Hospital de Clínicas de Porto Alegre were assessed and submitted to surgical resection of fibroadenomas. Fragments of the central area of the fibroadenoma and adjacent normal mammary tissue were obtained. mRNA expression for genes p53 and p21 was evaluated by RT-PCR, and protein expression by the western blot. Paired analyses showed higher gene expression of p53 (P = 0.017) and p21 (P = 0.003), and a higher protein expression of p53 (P = 0.001) in fibroadenomas as compared to normal breast tissue. p21 protein expression was not different (P = 0.97) between the fibroadenoma and the adjacent normal mammary tissue samples. These results suggest the participation of p53 in the formation of fibroadenomas. The role of p21 in fibroadenomas remains to be defined.     

结直肠癌中CDX2、p21~(H-ras)、p21~(WAF1)表达的临床意义

背景:CDX2与肠源性肿瘤的发生密切相关,而p21表达减低或缺失可能是结直肠癌发生、发展中的一个普遍事件。目的:探讨结直肠癌中CDX2、p21~(H-ras)、p21~(WAF1)表达的相关性和临床病理意义。方法:收集45例临床病理资料完整的结直肠癌手术切除标本,以免疫组化方法检测癌组织和相应癌旁组织中的CDX2、p21~(H-ras)、p21~(WAF1)蛋白表达。结果:结直肠癌组织中CDX2、p21~(H-ras)、p21~(WAF1)阳性率分别为86.7%、68.9%和35.6%,相应癌旁组织中阳性率分别为100.0%、37.8%和51.1%,CDX2和p21~(H-ras)在癌组织和癌旁组织中的阳性率差异有统计学意义(P=0.026和P=0.006);半定量分析结果显示CDX2和p21~(WAF1)在癌组织和癌旁组织中的表达水平差异有统计学意义(P=0.007和P=0.005)。癌组织中CDX2与p21~(H-ras)的表达存在相关性(r_s=0.501,P=0.000)。Dukes A、B期患者癌组织p21~(WAF1)阳性率显著高于C、D期患者(P=0.016),有淋巴结转移者p21~(WAF1)阳性率显著低于无淋巴结转移者(P=0.048),CDX2、p21~(H-ras)的表达与结直肠癌各临床病理特征均无相关性。结论:CDX2、p21~(H-ras)、p21~(WAF1)表达改变可能与结直肠癌的发生、发展相关。