胃粘膜肠上皮化生的内镜分析

目的探讨内镜下胃粘膜肠上皮化生诊断的可行性及准确度。方法应用放大或普通型内镜对受检者的胃底、胃体及胃窦进行仔细观察,详细描述肠上皮化生的表现特点并至少于胃窦小弯、大弯及胃体各取活组织检查(简称活检)一块,收集同期病理诊断肠上皮化生的病例并将内镜表现与病理进行对照分析。结果同期病理组织学诊断肠上皮化生患者329例。根据内镜下的特异性肠上皮化生的表现淡黄色结节型、瓷白色小结节型、鱼鳞型和弥漫型,内镜诊断肠上皮化生134例,经活检病理证实128例,内镜诊断符合率95.5％。胃粘膜活检诊断而内镜未予诊断者201例,内镜检查诊断肠上皮化生的总符合率38.9％。轻、中、重度肠上皮化生内镜诊断率不同,分别为23.8％、48.5％和51.7％。而放大内镜对轻、中、重度肠上皮化生诊断准确率分别为47.5％、78.5％和75.4％,明显高于普通型内镜组的14.9％、28.6％和34.9％,差异有显著性(P＜0.05)。结论胃粘膜肠上皮化生内镜表现除淡黄色结节型和弥漫型外,尚有鱼鳞型和瓷白色小结节型,这四种典型的肠上皮化生形态学特征,是内镜诊断肠上皮化生的特异型标志。这四种肉眼形态学特征与病理肠上皮化生程度无关,但肠上皮化生程度与内镜诊断呈平行关系。放大内镜对肠上皮化生诊断率明显高于普通型内镜。     

胃粘膜肠上皮化生及其与胃癌的关系

本着重探讨了胃粘膜肠上皮化生的分类及其和胃癌的关系，对胃癌的组织发生与防治研究具有积极意义。     

胃黏膜萎缩、肠上皮化生及异型增生的放大内镜表现及其诊断价值

目的 确定胃黏膜萎缩、肠上皮化生及异型增生的形态学特征，探讨放大内镜结合染色对上述病变诊断的可行性和准确性。方法 应用Fujinon EG485 ZH型放大内镜对100例患者进行检查及0．5％美蓝染色，在确定A、B、C、D、E 5型基本胃小凹形态的基础上，制订放大内镜的诊断分型及放大内镜对萎缩、肠上皮化生和异型增生的判定标准，与相应部位活检所获得的417个病变组织的病理组织学检查结果进行比较分析。结果 胃黏膜萎缩主要表现为胃小凹粗大而分布稀疏，肠上皮化生表现为C、D、E型小凹形态伴美蓝着色阳性，异犁增生表现为轻度凹陷、隆起或平坦性病变伴细微结构消失、细微小凹或细微结构粗糙紊乱放大内镜对萎缩诊断的敏感性、特异性分别为95．85％和95．09％；对肠上皮化生分别为88．30％和90．83％；对异型增生分别为91．52％和94．41％，均明显高于普通内镜。结论 根据放大内镜下萎缩、肠上皮化生和异型增生的形态学特征可以使内镜对上述病变诊断的准确性明显提高。     

放大内镜对胃黏膜肠上皮化生及萎缩的观察研究

目的应用高清晰放大胃镜观察研究胃黏膜肠上皮化生小凹形态的特点,并与病理学黏液组织化学染色结果进行对照,以提高胃镜下早癌的检出率。方法使用高清晰放大电子胃镜对因上消化道症状就诊的患者进行检查,观察胃黏膜微细形态,并予1%亚甲蓝喷洒,判断肠上皮化生部位,并于各不同形态处取活组织检查。结果人选患者共109例,共观察及活检115个部位,黏膜微细形态可分为6型,其中4型、5型是肠上皮化生的特征性形态,6型是萎缩的特征。结论高清晰放大胃镜下胃黏膜肠上皮化生小凹由正常变为椭圆状甚至绒毛状。依据这些特征可指导活检,避免普通胃镜检查活检的盲目性,提高肠上皮化生的检出率。     

色素内镜对胃黏膜肠上皮化生的分析及诊断价值

胃黏膜肠上皮化生（IM）是目前国内外公认的癌前病变之一，若能及早通过内镜下识别和治疗使其病变逆转．不失为防治胃癌的有效途径。探讨内镜诊断胃黏膜肠上皮化生．对识别胃黏膜癌前病变准确性提出了更高的要求。献报道，放大内镜对诊断IM准确性达89．69％，但基层医院的内镜医师由于受放大内镜设备的限制。如何利用普通内镜提高对IM诊断率，是值得探讨的。我们采用普通染色内镜进行观察，以探讨其对IM病变诊断的可行性和准确性。     

胃粘膜肠上皮化生及其与胃癌的关系

本文着重探讨了胃粘膜肠上皮化生的分类及其和胃癌的关系,对胃癌的组织发生与防治研究具有积极意义。     

胃黏膜肠上皮化生内镜诊断和分级的研究进展

胃黏膜肠上皮化生（gastric intestinal metaplasia,GIM）是一种癌前组织病理学改变,其临床意义在于对胃癌发生风险的提示,有着大面积肠上皮化生背景的胃黏膜具有较高的癌变风险;另外,不完全型GIM与肠型胃癌相关。因此,GIM的内镜下监测对及时发现和管理早期胃癌具有重要意义。可操作的GIM胃癌风险评估分级提供了较好地针对肠上皮化生的胃黏膜癌变风险评估,但每次评估需要标准的活检,增加了损伤风险,GIM内镜分级在此背景下被提出,但其应用受内镜诊断GIM的准确性和临床使用的便捷性所制约。笔者分析了各类内镜下诊断技术对GIM的诊断效果,结合人工智能辅助识别GIM面积,综述EGGIM评分的可行性。     

FICE放大内镜联合乙酸染色对诊断胃黏膜肠上皮化生的价值

目的探讨富士能智能分光染色内镜(FICE)放大内镜联合乙酸染色对胃黏膜肠上皮化生(GIM)的诊断价值。方法疑似GIM患者480例随机分为普通内镜组、乙酸染色组、美蓝染色组、FICE放大内镜联合乙酸染色组各120例,以病理诊断为金标准,比较不同方法诊断肠上皮化生的差异。结果普通内镜组与乙酸染色组诊断GIM的灵敏度、特异度、准确率差异无统计学意义(P>0.05),美蓝染色组与乙酸染色组的灵敏度、准确率差异有统计学意义(P<0.05)。FICE放大内镜联合乙酸染色组与美蓝染色组的特异度、准确率差异有统计学意义(P<0.05);FICE放大内镜联合乙酸染色组的阳性似然比、优势比、Kappa值均明显高于美蓝染色组,阴性似然比则明显低于后者(P<0.05)。结论 FICE放大内镜联合乙酸染色可提高GIM定向活检准确率,显著降低漏诊率及误诊率,且与病理诊断的一致性较好,具有更高的临床诊断应用价值。     

犬胃粘膜肠上皮化生模型的建立及其肠化过程中癌相关蛋白的表达

目的 系统观察胃粘膜肠化生长的形成及其发展趋势以及病变过程中癌相关基因蛋白表达。方法 应用低浓度甲硝基亚硝基胍（MNNG）及抑酸剂雷尼替丁联合喂饲,辅以胃部间断X线照射方法建立Beagle(毕格）犬胃粘膜肠化生动物模型。运用免疫组化法对胃粘膜活检组织APC、p53、K-ras、bcl-2基因蛋白表达进行了分析。结果 运用MNNG 雷尼替丁 局部X线照射方法成功地建立了毕格犬胃粘膜肠化生模型,采用此模型动态观察胃粘膜病变过程,证实了正常→浅表胃炎→萎缩胃炎→灶状肠化→中重度肠化变化规律。并发现癌基因bcl-2蛋白在萎缩性胃炎中既可表达,在肠化组织中可检出抑癌基因APC、癌基因K-ras蛋白表达。结论 MNNG 雷尼替丁 局部X线照射是建立毕格犬胃粘膜肠化生模型有效方法,犬胃粘膜肠化生经历了与人体相似变化过程,癌相关基因bcl-2、APC、K-ras蛋白在犬胃粘膜肠化生及癌变中可能起一定作用。     

内镜下射频消融术治疗胃黏膜萎缩伴肠上皮化生的效果观察

目的 探讨内镜下射频消融术治疗胃黏膜萎缩伴肠上皮化生的效果。方法 收集50例胃黏膜萎缩伴肠上皮化生患者的临床资料,患者均经射频消融术治疗,分析治疗前、治疗6个月和1年的病理、OLGA分期和OLGIM分期及尾型同源盒转录因子（CDX-2）、黏蛋白家族成员（MUCI、MUC2、MUC13）、绒毛蛋白（VIL）、p53等典型肠上皮化生因子变化。结果 与治疗前比较,射频消融术治疗6个月和1年,患者病理变化、OLGA分期和OLGIM分期差异有统计学意义（P均<0.05）。但患者治疗前后的CDX-2、MUC1、MUC2、MUC13、VIL、p53等典型肠上皮化生因子均呈阳性反应,差异无统计学意义（P均>0.05）。结论 内镜下射频消融术治疗可延缓胃黏膜萎缩伴肠上皮化生进展,且不影响患者典型肠上皮化生因子的分子水平。     

Correlation between Endoscopic and Histological Diagnoses of Gastric Intestinal Metaplasia

Background/Aims

Intestinal metaplasia (IM) is a premalignant condition. This study aimed to evaluate the correlation between endoscopic and histological findings of IM.

Methods

The cases of IM were graded by conventional endoscopy, and biopsies were taken from the antrum and body of 1,333 subjects for histological IM diagnosis. Multivariate analyses were performed to identify the factors that affect the sensitivity of endoscopic IM diagnosis.

Results

The sensitivity/specificity of endoscopic IM diagnosis based on histology was 24.0%/91.9% for the antrum and 24.2%/88.0% for the body. As indicated by multivariate analysis, the presence of endoscopic atrophic gastritis (AG) (odds ratio [OR], 4.73; 95% confidence interval [CI], 2.07 to 10.79) and the activity of mucosal inflammation (OR, 2.21; 95% CI, 1.08 to 4.54) were associated with the sensitivity of endoscopic IM diagnosis in the antrum, while the presence of endoscopic AG (OR, 8.02; 95% CI, 4.55 to 14.15), dysplasia (OR, 2.40; 95% CI, 1.07 to 5.39), and benign gastric ulcers (OR, 0.35; 95% CI, 0.15 to 0.081) were associated with the sensitivity of endoscopic IM diagnosis in the body.

Conclusions

As the sensitivity of endoscopic IM diagnosis was low, a high index of suspicion for IM is necessary in the presence of atrophy, and confirmation by histology is also necessary.     

Progression of Atrophic Gastritis and Intestinal Metaplasia Drives Helicobacter pylori Out of the Gastric Mucosa

This study was performed to evaluate the implication of anti-H. pylori IgG positivity when CLOtest, histological test, and culture in the antrum and body are all negative, and to find out the specific disease category that is more affected by the hostile relationship of atrophic gastritis and intestinal metaplasia (IM) with H. pylori. Four hundred thirty-six patients (84 controls, 69 with duodenal ulcer, 96 with benign gastric ulcer, 43 with dysplasia, 144 with gastric cancer), who had not received any eradication therapy, were divided into three groups according to H. pylori test: CLOtest or histological H. pylori-positive group (group A; 294 cases), only anti-H. pylori IgG-positive group (group B; 62 cases), and anti-H. pylori IgG-negative group (group C; 80 cases). The grade of neutrophil and monocyte infiltration, atrophic gastritis, and IM was compared according to the updated Sydney system classification. Neutrophil and monocyte infiltrations were significantly severe in the group A. In contrast, the grade of atrophic gastritis and IM in the antrum was significantly higher in group B than the other two groups, A or C. When patients were divided according to the disease outcome in each group, the grade of IM in the body was statistically higher only in the patients with cancer or dysplasia in group B. These results suggest that anti-H. pylori IgG positivity with all negative invasive H. pylori tests represents past infection with H. pylori rather than a false negative, especially in the case of dysplasia and gastric cancer.     

胃黏膜炎症和肠上皮化生与幽门螺杆菌长期感染分析

目的 探讨幽门螺杆菌(Hp)长期感染及根除与胃黏膜炎症和肠上皮化生(IM)的关系.方法 随访142例4年前和156例7年前Hp感染者,分析对比其前后Hp感染情况、胃黏膜炎症和IM的变化.结果 4年前Hp阳性142例中,现在104例(73.2%)Hp仍呈阳性,38例(26.8%)转阴.7年前Hp阳性的156例中,现在118例(75.6%)Hp仍呈阳性,38例(24.4%)转阴.Hp长期阳性者4年前和现在及7年前和现在的慢性炎症严重程度积分分别为1.635±0.376与1.808±0.301(P＞0.05)和1.661±0.398与2.232±0.335(P＜0.01);IM发生率分别为17.3%(18/104)与26.9%(28/104)(P＞0.05)和11.9%(14/118)与39.0%(46/118)(P＜0.01);IM严重程度积分分别为1.444±0.527与1.667±0.442(P＞0.05)和1.571±0.534与2.286±0.488(P＜0.05).Hp转阴者4年前和现在及7年前和现在的慢性炎症严重程度积分分别为1.684±0.369与1.367±0.426(P＜0.05)和1.647±0.389与1.182±0.396(P＜0.01);IM的发生率为31.6%(12/38)和52.6%(20/38);IM严重程度积分分别为1.333±0.516与1.167±0.775(P＞0.05)和1.600±0.516与1.100±0.316(P＜0.05).结论 Hp感染持续时间越长,胃黏膜炎症越严重,可能IM程度亦越严重,且发生率高;根除Hp不仅能减轻胃黏膜的炎症程度和IM程度,也可能防止IM的发生.     

Altered Expression of a Li-Cadherin in Gastric Cancer and Intestinal Metaplasia

The aims of this study were to examine Li-cadherin expression in 74 gastric carcinoma tissues, 10 cases with normal gastric tissues, and 21 cases with intestinal metaplasia and to investigate the role of Li-cadherin in cell differentiation, cancer invasion, and metastasis. Expression of Li-cadherin was analyzed by immunohistochemistry and semiquantitative polymerase chain reactio and correlated with clinicopathological parameters. Immunohistochemistry showed that Li-cadherin was mainly present on the cell membrane and there was no staining for liver–intestine cadherin in normal tissues. The reduction of Li-cadherin mRNA expression was inversely correlated with the grade of differentiation (P < 0.05). Significant differences in the expression of liver–intestine cadherin were found in lymphatic metastasis of the tumors (P < 0.05), but the expression of liver–intestine cadherin was not associated with gender (P=0.748), serosal invasion (P=0.136), TNM stage (P=0.172), Helicobacter pylori infection (P=0.572), liver metastasis (P=0.374), or peritoneal metastasis (P=0.621). Multivariate analysis revealed that the expression of Li-cadherin is an important predictor of lymph node metastasis. We conclude that there is a significant correlation between Li-cadherin expression and the differentiation of gastric carcinoma, and Li-cadherin can be a good marker to detect gastric cancer at early stages. Increased Li-cadherin expression may contribute to gastric cancer invasion to lymph nodes.     

幽门螺杆菌与肠化生相关性的初步研究

目的：为了初步探讨幽门螺力与肠化生的相关性。方法：应用ＣＬＯ－ｔｅｓｔ,组织学和分子生物学方法联合检测６５例胃粘膜活检标本中ＨＰ感染。结果：表明肠化生组织中ＨＰ的检出率显著高于正常组。结论：ＨＰ感染与患者年龄,性别无关。ＨＰ可能在从浅表性胃炎→肠化生→不典型增生→胃癌的发生过程中起一定作用。     

Helicobacter pylori Infection is Associated with a High Incidence of Intestinal Metaplasia in the Gastric Mucosa of Patients at Inner-City Hospitals in New York

Gastric carcinogenesis is a multistep process progressing from chronic gastritis, through glandular atrophy (GA), intestinal metaplasia (IM) and dysplasia. Infection of the stomach with H. pylori increases the risk of developing gastric cancer. Few studies have examined the degree to which Hp-induced changes occur in specific populations. In the present study, we examined the association between Hp infection and histological changes in the gastric mucosa of patients at two inner-city hospitals in New York. Patients enrolled in this study were undergoing endoscopy for gastrointestinal complaints. One antral biopsy was taken for detecting and genotyping Hp by PCR. Additional biopsies were taken from the antrum and fundic region for histological analysis and were scored with respect to acute and chronic inflammation, GA, IM and Hp infestation according to the Sydney classification. Hp strains infecting these patients were genotyped with respect to the expression of Hp virulence factors including VacA, CagA, and BabA2. Samples were collected from 126 patients at Kings County Hospital in Brooklyn and St. John’s Episcopal Hospital in Queens. Hp infection rates were highest in Blacks (41.6%) and Hispanics (29.4%) and lowest in Caucasians (18.8%). Scores for acute and chronic inflammation and IM were higher in Hp-infected individuals in both the antrum and fundic regions, whereas Hp infection did not affect the incidence or intensity of GA. In Hp-infected individuals, the incidence of IM was greater in the antrum (Hp-infected 37.8% vs. non-infected 9.2%, p < 0.05) and fundic region (Hp-infected 15.1% vs. non-infected 1.8%, p < 0.05). Genotyping of the Hp strains infecting these patients revealed that the predominant VacA allele was s1bm1 and that the CagA gene was present in 69.8% of Hp-infected samples. Interestingly, the BabA2 gene was detected in only four samples (9.3%). The incidence of IM in the antrum was higher in CagA+ samples when compared with CagA- samples (52.2% vs. 15.4%, respectively). Our findings indicate that the virulent Hp strain infecting minority patients treated at inner-city hospitals in New York City is associated with a high incidence of IM and that these patients may be at greater risk for developing gastric cancer than the general population. Support: This work was supported by grants from the Rosalyn S. Yalow Foundation for Medical Research and the Cancer Research and Prevention Foundation.     

胃粘膜肠化与胃癌的CEA免疫组化和DNA定量研究

我们应用ABC免疫组化和显微分光光度法,观察了胃癌及不同类型肠化组织中CEA的表达和DNA含量的变化.发现肠型胃癌CEA染色阳性率显著高于胃型胃癌(P<0.001);Ⅲ型肠化中CEA的阳性率显著高于Ⅰ、Ⅱ型肠化(P<0.001)。细胞核DNA含量和超3C及超4C细胞的比率均随细胞去分化程度而递增。Ⅲ型肠化DNA均值显著高于Ⅰ、Ⅱ型肠化和正常胃粘膜(P<0.05～0.01)。结果表明,Ⅲ型肠化与胃癌的发生有密切关系。     

胃上皮异型增生及肠化生时PCNA、p27蛋白和Survivin表达

目的检测胃上皮异型增生并不同肠上皮化生组织中PCNA、p27蛋白和生存素(Survivin)的表达。方法应用组织化学法和免疫组织化学S-P法检测44例结肠性化生(其中低度异型增生27例,高度异型增生17例)和51例小肠性化生(其中低度异型增生42例,高度异型增生9例)胃活检组织中PCNA、p27蛋白和Survivin的表达。结果PCNA和Survivin蛋白在胃上皮异型增生并结肠性化生与小肠性化生间的表达率差异有显著性。低度异型增生和高度异型增生间PCNA和Survivin蛋白表达率差异有显著性。p27蛋白在结肠性化生与小肠性化生间、低度异型增生和高度异型增生间表达差异无显著性。结论PCNA、p27和Survivin基因的改变不仅与肠上皮化生的类型有关,而且与胃上皮异型增生的程度密切相关。     

激光共聚焦内镜对慢性萎缩性胃炎和肠上皮化生的诊断价值

目的 比较共聚焦内镜与普通白光内镜对萎缩性胃炎和肠上皮化生的诊断价值。方法对2012年1月至5月来我院行胃镜检查的89例患者,全部在普通白光内镜及共聚焦内镜下对胃黏膜进行观察,并对病变部位进行活检病理学诊断。结果89例患者共观察286个病变部位。普通内镜诊断萎缩性胃炎95个部位,共聚焦内镜诊断40个部位,病理学诊断萎缩37个部位,共聚焦内镜与病理学诊断符合率为94．6％,普通内镜与病理学诊断符合率为38．95％;普通内镜诊断肠上皮化生54个部位,共聚焦内镜诊断170个部位,靶向活检诊断161个部位,共聚焦内镜与病理学诊断符合率为84．47％,普通内镜与病理学诊断符合率为33．54％。共聚焦内镜对萎缩性胃炎和肠上皮化生的诊断符合率明显高于普通内镜组,并且共聚焦内镜与病理学诊断具有很好的一致性（P=0．453,kappa值=0．895和P=0．298,kappa值=0．577）。结论共聚焦内镜对萎缩性胃炎和肠上皮化生具有较高的诊断价值,值得临床推广。