MORPHOMETRIC ANALYSIS AND MODEL ASSESSMENT OF GASTRIC CARCINOMA AND PRECANCEROUS LESIONS OF STOMACH

Ninety-four pathologic specimens of gastric mucosa with lesions including simple intestinal metaplasia, intestinal types of mild, moderate, severe dysplasia and gastric carcinoma were submitted to morphometric analysis by an automated image analysis system. Four kinds of indices and four geometric parameters were measured. They were: (1) Index of Structural Atypism (ISA); (2) Index of Glandular Formation (IGF); (3) Index of Nuclei-Gland ratio (ING); (4) Widthen of Nuclear Band (WNB); (5) Geometric parameters of cell nuclei: including Area, Perimeter, Mean Diameter, and Contour. Apart from Contour, these variables were increased with increasing degrees of atypism in the various types of gastric mucosal lesions. Hence the indices and parameters may be used as objective diagnostic criteria. An assessment model was established for discriminating various types of lesions. The coincidence rate between the model assessment and the original histopathologic diagnosis was 86.1%. Morphometric analysis may provide a means of standardizing pathologic diagnosis and grading of gastric precancerous lesions.     

胃癌及其癌前病变核仁组成区相关蛋白的定量研究（Ⅱ）

应用核仁组成区相关蛋白（ＡｇＮｏＲｓ）染色观察５２例不同类型肠上皮化生（简称肠化生），１１例中重度异型增生、３０例胃窦癌及４例正常胎儿胃粘膜和２０例正常胃粘膜ＡｇＮＯＲ量的变化，发现Ⅲ型肠化生ＡｇＮＯＲ计数显著高于Ⅰ、Ⅱ型肠化生（Ｐ＜０．０５）。从正常胃粘膜上皮，经肠上皮化生到中重度异型增生到胃癌，ＡｇＮＯＲ计数随细胞异型程度的加重而递增，各组间均见显著性差异（Ｐ＜０．０５）。结果表明，Ⅲ型肠化生与胃癌的发生有密切关系，具有较高ＡｇＮＯＲ计数的中重度异型增生是重要的癌前病变。     

THE ROLE OF HELICOBACTER PYLORI IN GASTRIC CANCER AND PRECANCEROUS LESIONS

Objective To determine the role of Helicobacter pylori ( Hp ) in the development of gastric cancer and gastric precancerous lesions. Methods From the biopsy specintestinal metaplasiaens of gastric cancer and precancerous lesions lip organisms were detected by a combination use of three methods ( Clo-test,Giemsa and PCR ). Mutations of C-Ha-ras and p53 genes were determined by polymerase chain reaction-single strand conformation polymorphism analysis-direct sequencing ( PCR-SSCP-S ) . Results The detection rates of lip in gastric cancer, dysplasia and intestinal metaplasia were significantly higher than that of normal gastric mucosa , and the mutational rates of C-Ha-ras and p53 genes in Hp positive patients were significantly higher than those in lip negative patients. In gastric cancer patients, the mutational rate of p53 gene in lip positive patients was significantly higher than that of lip negative patients, in which spot mutation was the main pattern of gene changes.Conclusion Hp infection might be related to gastrocarcinogenesis and gene mutation might play a role in Hp related gastric cancer.     

胃癌和癌前病变免疫组化与组化的研究

应用胃癌单克隆抗体ＭＧ７、高铁二胺－阿尔新蓝（ＨＩＤ／ＡＢ）及核仁组成区（ＡｇＮＯＲｓ）等免疫组织化学（免疫组化）与组织化学（组化）染色方法，对９０例胃粘膜及胃癌组织进行研究。结果表明，ＭＧ７在胃癌原发灶及淋巴结转移灶癌细胞的阳性率分别为７６．７％和１００％，萎缩性胃炎为２５％，胃癌与非癌组间有显著性差异（Ｐ＜０．０１）。在各组的病变组织中，ＡｇＮＯＲｓ计数均值随异型程度的加重而递增，胃癌与非肿瘤病变组间有明显的差异（Ｐ＜０．０５）。１６例ＨＩＤ阳性的大肠型肠上皮化生（肠化）病变中有８例ＭＧ７抗原表达，占５０％，在１５例ＨＩＤ阴性的小肠型肠化中，无１例呈ＭＧ７阳性反应，两者之间也有明显差异（Ｐ＜０．０５）。     

ASSOCIATION OF HELICOBACTER PYLORI INFECTION WITH PRECANCEROUS LESIONS AND STOMACH CANCER. A CASE-CONTROL STUDY IN YANGZHONG COUNTY

Previous study has raised H. pylori infection as a suspected biologic risk factor for gastric cancer. A comparative case-control study involving precancerous lesions and gastric cancer was conducted in Yanzhong county, an area with one of the highest rates of gastric cancer in China to study the relationship between the H. pylori infection and gastric cancer. Subjects in the study were all randomly selected participants of a screening program for gastric cancer sponsored by the Cancer Institute of CAMS in cooperation with Yangzhong county Hospital. Totally, 125 normal controls, 108 superficial gastritis, 111 atrophic gastritis and 110 gastric cancer patients were included in our study according to endoscopy and pathology, result. Status of H. pylori infection was evaluated by measuring Ig G antibody in plasma with ELISA assay.Our result showed Odds ratios of H. pylori infection were higher among gastritis and cancer groups, 4.5(95% CI 2. 5-7.9) for superficial gastritis, 6.3 (95% CI 3.4-12) for atrophic gastritis, 3. 3 (95% CI 1.9-5.9) for gastric cancer. It was found in our study that consumption of pickled vegetables and drinking dirty water increased the relative risk of H. pylori infection for both precancerous lesions and gastric cancer and that H. pylori infection had higher risk of atrophic gastritis and gastric cancer for males and also higher risk of atrophic gastritis for olders. Our results strongly support the casual role played by H, pylori infection in the carcinogenic process of gastric mucosa.     

胃癌及癌前病变MG7—Ag表达的免疫组织化学研究

应用抗胃癌单克隆抗体MG_7ABC法标记正常胃粘膜、胎儿食道、胃、结肠粘膜和胃癌及癌前病变组织标本.MG_7对胃癌的特异性高,MG_7-Ag在胃癌中的阳性表达率为86.7%,强阳性表达率为53.3%,显著高于肠上皮化生及中重度异型增生.MG_7不与正常胃粘膜反应,但可与胎儿食道、胃、结肠粘膜反应.结果表明,MG_7免疫组化有助于胃粘膜良恶性病变的鉴别和胃癌的早期诊断.     

宫颈癌癌前病变及宫颈癌与HPV感染的关系

目的： 评价宫颈癌前病变及宫颈癌与宫颈人乳头状瘤病毒 （ Ｈ Ｐ Ｖ） 感染的关系。方法： 对１５８ 例宫颈涂片异常患者进行阴道镜下宫颈多点活检同时行宫颈 Ｐ Ｃ Ｒ Ｈ Ｐ Ｖ Ｄ Ｎ Ａ 检测。结果： 慢性宫颈炎、低度鳞状上皮内病变 （ Ｌ Ｓ Ｉ Ｌ） 、高度鳞状上皮内病变 （ Ｈ Ｓ Ｉ Ｌ） 和宫颈癌的 Ｈ Ｐ Ｖ １６／１８ 感染率分别为８６６ ％ 、３４６９ ％ 、６８８９ ％ 和８３３３ ％ , Ｈ Ｓ Ｉ Ｌ 的 Ｈ Ｐ Ｖ １６／１８ 感染率明显高于 Ｌ Ｓ Ｉ Ｌ （ Ｐ＜ ００１） 。 Ｈ Ｐ Ｖ １６／１８ （ ＋ ） 的 Ａ Ｓ Ｃ Ｕ Ｓ 中 Ｈ Ｓ Ｉ Ｌ 检出率明显高于 Ｈ Ｐ Ｖ １６／１８ （ － ） , Ｈ Ｐ Ｖ １６／１８ （ ＋ ） 的 Ｌ Ｓ Ｉ Ｌ 中 Ｈ Ｓ Ｉ Ｌ 检出率明显高于 Ｈ Ｐ Ｖ １６／１８ （ － ） 。结论： 宫颈癌前病变、宫颈癌与 Ｈ Ｐ Ｖ １６／１８ 感染密切相关, 随着病变程度的加重, Ｈ Ｐ Ｖ １６／１８检出率升高, 提示 Ｈ Ｐ Ｖ １６／１８ 为宫颈癌的高危因素。宫颈 Ｐ Ｃ Ｒ Ｈ Ｐ Ｖ １６／１８ Ｄ Ｎ Ａ 的检测可用于 Ａ Ｓ Ｃ Ｕ Ｓ、 Ｌ Ｓ Ｉ Ｌ 患者活检前的筛查。     

口腔粘膜癌前病变纽胞核DNA含量的定量分析

采用流式细胞光度术(FCM)对51例口腔粘膜样本进行了细胞核DNA含量及细胞周期分析,发现由正常组织、单纯增生、轻增、重增到鳞癌的DNA含量及S时相细胞的百分比是逐渐增加的。异常增生与正常组织、单纯增生相比差异有显著性。异常增生和鳞癌中有异倍体出现,轻增、重增、鳞癌的异倍体出现率分别为40%,50%70%。结果表明,口腔粘膜由正常组织、单纯增生、轻增、重增到鳞癌是一个连续的发展过程,其增殖活性逐渐升高。DNA含量和S时相百分比是反映异常增生和癌变的客观指标。     

胃癌癌前病变的AgNOR定量研究

应用AgNOR染色技术对慢性表浅性胃炎(CSG)、慢性萎缩性胃炎(慢性萎缩性胃炎伴肠上皮生—CAG with IM及慢性萎缩性胃炎伴不典型增生CAG with Dys)和胃癌(GC)活检标本进行细胞核内AgNOR的定量研究。结果表明CSG组与CAG组、CAGwith IM组与GC组、CAGwith Dys组与GC组以及CAGwithIM组与CAGwithDys组细胞核内AgNOR均数比较都有极显著差异(P<0.01)。此外,各组AgNOR颗粒大小、位置和形态分布也不同,特别是CAGwith Dys组、CAGwith IM组合分别与GC组相比较,前者在AgNOR均数、大颗粒和不规则颗粒的百分比方面均比后者更接近于GC组数值,提示慢性萎缩性胃炎伴不典型增生与胃癌发生的关系更为密切。     

胃良恶性病变组织中端粒酶的活性研究

目的:探讨胃癌和胃良性病变中端粒酶的活性及其临床意义.方法:应用TRAP-PCR-ELISA方法检测36例胃癌组织,20例胃溃疡组织,10例胃炎组织和20例正常人胃黏膜组织中端粒酶的活性.结果:胃癌组织中端粒酶阳性率分别为80.6%(29/36),胃良性病变组织中端粒酶阳性率为10%(其中2例胃溃疡和1例胃炎组织标本检测到端粒酶活性),正常人胃黏膜组织未检测到端粒酶阳性.胃癌组织与胃良性病变组织中端粒酶阳性率比较,差异有统计学意义(P＜0.01).结论:端粒酶活性是判断胃良恶性肿瘤的一个重要指标,对胃良性病变患者端粒酶检测阳性者应加强随访.     

S100 PROTEIN-POSITIVE DENDRITIC CELLS AND THE SIGNIFICANCE OF THEIR DENSITY IN GASTRIC PRECANCEROUS LESIONS

Quantitative analysis of dendritic cells (DC's) was carried out in tissue specimens of normalgastric mucosa (n=15),gastric ulcer (n=19),chronic atrophic gastritis (n=28),and gastriccarcinoma (n=65) by ABC immunostaining with S100 protein antibody.Significant increasein DC number were observed in chronic atrophic gastritis with type Ⅲ intestinal metaplasiaand/or grade Ⅱ,Ⅲ dysplasia.The result suggests that DC's are potentially capable opresenting neoantigens associated with malignant transformation at the precancerous stagewhen malignant morphological changes have not yet taken place.Combined with routinediagnostic methods,the serial monitoring of DC density in gastric mucosa may be usefulin the follow-up of premalignant lesions in the stomach and the diagnosis of early gastriccarcinoma.     

喉癌下咽癌及其癌前病变的端粒酶活性检测

目的： 探讨端粒酶活化在喉癌和下咽癌发生发展中的作用。方法： 采用改良的银染端粒重复序列扩增法对５８ 例喉癌下咽癌组织、２５ 例癌旁组织和１０ 例癌前病变组织进行了端粒酶活性检测。结果： ５８ 例喉癌和下咽癌中５３ 例阳性， 阳性率９１４ ％ ； ２５ 例癌旁组织中３ 例阳性， 阳性率１２ ％ ； １０ 例癌前病变中７ 例阳性， 阳性率７０ ％ 。结论： 端粒酶活化在喉癌、下咽癌及其癌前病变组织中表达极高， 对阐明喉癌和下咽癌的发病机理和癌变风险估计有重要意义， 有可能成为咽喉癌早期诊断的生物学标记物。     

端粒酶在胃癌和癌前病变中的表达及相关性研究

目的:探讨胃癌及癌前病变中端粒酶(hTERT)的表达及临床意义.方法:采用原位杂交方法,检测了130例石蜡包埋标本.结果:1.端粒酶(hTERT)主要分布在细胞浆中,在慢性浅表性胃炎(CSG) 、慢性萎缩性胃炎(CAG) 、非典型增生(DYS) 及胃癌(GC)中表达率分别是0%、10%、30%、78.75%.在GC中表达率最高,GC组中的端粒酶与CSG 、CAG、DYS相比P＜0.01.2. 80例胃癌中,端粒酶在高分化、中分化、低分化癌中表达率分别为71.43%,75%,75%,各组之间无差异性(P>0.05).结论:端粒酶的表达与胃癌的发生密切相关.端粒酶检测对胃癌诊断具有重要意义,是一个很好的恶性肿瘤标记物;端粒酶表达强度与胃癌的分化程度无相关性.     

微量胃液单克隆抗体筛查胃癌的研究

目的 :探讨胃癌的早期诊断。方法 :在 1 4 687例有消化道症状人群中筛选出 60 0例胃癌高危人群进行微量胃液单克隆抗体检测。结果 :对胃癌病人检测的敏感性为 86.66% ,特异性为 77.5 4% ,准确性为 78% ,阳性预测值为 1 5 .85 %。结论 :微量胃液单克隆抗体检测对胃癌的早期发现 ,及时进行胃癌的二级预防提供了有效途径。     

大肠癌及癌前病变细胞AgNORs研究

应用3种方法计数大肠癌及癌前病变细胞核仁组成区嗜银蛋白(AgNORs),并对AgNORs形态进行观察。结果表明,计数核液中所有银染颗粒的方法,能较好地将大肠肿瘤性病变(腺府、腺癌、腺瘤癌变)与非肿痫性病变(幼年性息肉、炎性息肉等)区别开来,且能较好地将大肠腺癌与腺瘤、癌旁粘腆区别开来,同时大肠腺痫细胞AgNORs计数与其组织民型增生程度及组织学类型有关,反映了重度异型增生与绒毛状腺瘤易于恶变的生物学特性。     

胸膜活检对结核性胸膜炎的诊断价值(附80例病例分析)

目的 :探讨胸膜活检对结核性胸膜炎的诊断价值。方法 :对 80例结核性胸膜炎患者胸膜活检的病理诊断阳性率、取材成功率进行总结 ,分析影响诊断阳性率的因素以及胸膜活检的并发症。结果 :80例中 44例 ( 55 0 % )病理组织学诊断阳性 ,增加活检次数可提高诊断阳性率 ;胸膜活检阳性率随发病至首次活检时间的缩短而升高 ,2周内进行活检的阳性率显著高于 2周后。 1 0 3例次胸膜活检发生气胸 3例次 ( 2 9% )。结论 :胸膜活检可作为诊断结核性胸膜炎安全有效的手段 ,早期活检阳性率较高。     

胃癌普查方法探讨

我室在5159名年龄35～64岁人中,采用特制的中空金属球吸取胃液,检测pH、OB、IgA和IgG,开展胃癌普查。检出胃液阳性者1250例,检出率为24.23％(1250/5159)。对835例胃液阳性者和87例胃液阴性者行胃镜病理检查,发现23例胃癌,均为胃液阳性者,癌检出率为0.45％(23/5159),其中早癌7例,占30.43％(7/23)。胃液阳性组癌～癌前期变化者检出率为61.32％(512/835),明显高于胃液阴性组的21.84％(19/87),经X~2检验有非常显著性意义(P<0.005)。此方法操作简单、安全病人痛苦小,癌检出率高,有一定实用价值。     

不同胃病患者胃粘膜组织脂质过氧化物的研究

本文应用荧光法对75例不同胃病患者胃粘膜组织进行了脂质过氧化物的测定。进而探讨脂质过氧化物对胃粘膜组织的损害作用。结果表明:慢性胃炎与正常组相比,脂质过氧化物无明显差异。胃癌组、胃溃疡组、残胃炎组与正常组相比,脂质过氧化物明显增高。提示:胃癌、胃溃疡、残胃炎与脂质过氧化物有关。本文还就脂质过氧化物与上述疾病的关系进行了讨论。     

MNNG诱发狗微小胃癌和癌前期病变的病理形态学研究

本文报告用MNNG溶液(250ug/ml),拌喂普通食物复制家狗胃癌模型的实验结果。在10只狗中,三只诱发了微小胃癌。共发现16个癌灶。分布在胃体和胃底、大小弯,为多发性;组织类型为高分化管状腺癌(9/16),及印戒细胞癌(7/16),位于粘膜内或粘膜下浸润;肉眼类型属Ⅱ_(b-c)型。系统地观察了各种癌前期病变的病理组织学变化及其与胃癌发生的关系。研究表明:重度慢性萎缩性胃炎伴重度非典型腺体增生是重要的癌前期病变,并提出了狗微小胃癌组织发生模式的初步设想。