PCNA在胃粘膜肠上皮化生、异型增生和胃癌中表达及意义的研究

目的研究增殖细胞核抗原(PCNA)在胃粘膜、肠上皮化生,异型增生及胃癌中的表达.评估胃癌前病变的发展趋势,进一步探讨胃癌发生的分子生物学机制.方法应用免疫组化技术测定115例患者的PCNA表达情况.其中50例肠上皮化生、15例异型增生、50例胃癌.结果PCNA的表达从肠上皮化生、异型增生到胃癌呈递增趋势.在肠上皮化生为轻度表达,异型增生以中度表达为主,而胃癌多呈重度和过度表达.PCNA强阳性表达与胃癌分化程度,侵润深度,淋巴结转移密切相关.结论PCNA在胃粘膜不同疾病细胞核内的表达、反映了细胞增殖状态和生长速度、有助于判断肠上皮化生、异型增生的发展趋势及判断与监测胃癌的预后.     

胃癌及胃癌前病变p53蛋白、PCNA表达及其临床意义的研究

目的探讨p53蛋白、增殖细胞核抗原(PCNA)在胃癌及胃癌前病变发生发展中的作用及其临床意义.方法采用免疫组织化学技术(S-P法).结果胃癌及胃癌前病变中p53蛋白、PCNA表达水平均高于正常胃粘膜(P＜0.05).表达水平从肠上皮化生、异型增生到胃癌均呈递增趋势.其在胃癌组织中的表达与组织类型、侵润深度、淋巴结转移密切相关(P＜0.05).结论 p53蛋白、PCNA表达对评估胃癌前病变发展趋势和判断胃癌预后具有重要临床价值.     

胃粘膜异型增生的细胞动力学改变——PCNA免疫染色观察

目的 评价PCNA在判断胃良性病变恶性趋势中的诊断价值,同时对癌前病变从细胞动力学角度做一些初步探讨。方法 应用PCNA免疫组化染色观察PCNA在胃粘膜异型增生、肠上皮化生、单纯再生粘膜以及正常粘膜和癌性上皮中的表达情况。结果 在胃正常粘膜、单纯再生及肠上皮化生组织中PCNA阳性表达较低,在异型增生组织中阳性表达明显增加(P<0.05)。结论 从细胞增殖动力学角度,提示胃粘膜异型增生是胃癌前期高危病变。PCNA可较客观地反映胃粘膜组织在各种病理状态下的生物学行为,作为辅助手段,具有一定临床指导作用。     

幽门螺杆菌感染与慢性胃炎、溃疡病、异型增生、胃癌的关系及PCNA表达

目的　探讨幽门螺杆菌感染的不同胃粘膜增殖性病变的演进中增殖细胞核抗原 (PCNA)的表达情况及其意义。方法　对 15 0例病理证实的不同胃粘膜病变用免疫组化的方法检测PCNA标记指数 (LI) ,Warthin -starry(W -S)法检测HP感染。结果　PCNA -LI在浅表性胃炎为 2 2 0 0± 16 95、萎缩肠化性胃炎 46 45± 19 10、溃疡病 45 75± 18 15、异型增生 61 0 6± 2 0 67。在萎缩肠化性胃炎、溃疡病、异型增生及胃癌组织中均高于浅表性胃炎 (P <0 0 5 )。萎缩肠化型胃炎、溃疡病、异型增生及胃癌组PCNA阳性表达中HP感染者多于阴性者。结论　PCNA表达与胃粘膜增殖和恶化有关。HP感染与胃粘膜增殖和恶化有关     

Ezrin和c-Met基因编码蛋白表达与胃癌发生和转移的关系及意义

目的:检测并分析Ezrin蛋白和c-Met蛋白在正常胃粘膜、肠上皮化生、不典型增生及胃癌组织中表达的差异性和关联性,探讨Ezrin蛋白及c-Met蛋白的表达与胃癌发生和转移的关系及意义.方法:收集手术切除胃癌标本219例(其中188例同时于距癌灶边缘大于5cm处取配对正常胃粘膜作为对照)、不典型增生75例及肠上皮化生85例.采用组织芯片制作仪构建胃癌及其癌前病变组织芯片,利用免疫组化方法检测Ezrin蛋白和c-Met蛋白在正常胃粘膜、肠上皮化生、不典型增生及胃癌中的表达.结果:除去抗原修复造成的部分组织脱落,最终可用病例分别为正常胃粘膜131例,肠上皮化生55例,不典型增生62例,胃癌182例.Ezrin蛋白在肠上皮化生(94.55%)、不典型增生(87.10%)和胃癌(83.52%)中表达的阳性率显著高于正常胃粘膜(61.07%),P<0.01;伴淋巴结转移胃癌组Ezrin蛋白表达的阳性率(88.32%)显著高于无淋巴结转移组(68.89%),P<0.01.c-Met蛋白在肠上皮化生(63.64%)、不典型增生(61.29%)和胃癌(65.93%)中表达的阳性率显著高于正常胃粘膜(28.24%),P<0.01;伴淋巴结转移胃癌组c-Met蛋白表达的阳性率(71.53%)显著高于无淋巴结转移组(48.89%),P<0.05.结论:Ezfin蛋白可能参与胃粘膜肠上皮化生和肠型胃癌的发生;Ezrin蛋白和c-Me蛋白共同参与了胃癌的发生和发展,但其具体分子机制尚需进一步深入研究.     

TFF1 TFF2在胃癌和癌前病变中的表达及意义

目的:观察三叶因子Ⅰ(Trefoil factor1,TFF1)、三叶因子Ⅱ(Trefoil factor 2,TFF2)在胃癌前病变(不典型增生和肠上皮化生)及胃癌的表达,探讨TFF1、TFF2表达与胃癌发生的关系.方法:对正常胃粘膜、胃粘膜肠上皮化生、胃癌组织各30例,采用SP免疫组化方法进行TFF1、TFF2蛋白的定位和半定量检测.结果:正常胃粘膜→肠上皮化生→不典型增生→胃癌四种病变中,TFF1、TFF2表达呈逐渐减弱趋势,差异具有显著性(P＜0.05).结论:TFF1、TFF2蛋白表达在胃癌发生过程中进行性下调,TFF1、TFF2蛋白表达可作为胃癌生物学行为的客观指标.     

胃癌及癌前病变中p53蛋白表达与HP感染的关系

目的 观察幽门螺旋杆菌(HP)感染后胃癌、胃粘膜异型增生和胃粘膜肠化生中p53蛋白表达的特点,探讨HP在胃癌发生发展过程中的作用.方法 应用免疫组化SP法及美兰染色,对胃癌79例,胃粘膜异型增生23例,胃粘膜肠化生21例进行p53蛋白表达及HP检测并与56例慢性胃炎对比分析.结果 胃癌组、胃粘膜异型增生组及胃粘膜肠化生组的HP感染率及p53蛋白阳性表达率均明显高于慢性胃炎组(P＜0.05);122例HP阳性者p53蛋白表达80例,阳性率65.6%,58例HP阴性者p53蛋白表达5例,阳性率8.6%,两者比较,差异显著(P＜0.05).结论 在慢性胃炎、胃粘膜肠化生、胃粘膜异型增生、胃癌的进展过程中,p53蛋白的表达水平在增高.HP感染在胃癌发生、发展过程中起一定作用.p53蛋白的表达可能是HP致癌的作用机制之一.     

胃粘膜结肠型化生和小肠型化生对p21、p53、EGFR、PCNA及CEA的联合表达

 目的　探讨胃粘膜的弱化生与胃癌之间的关系。方法　应用免疫组化S-P法,检测胃粘膜结肠型及小肠型化生细胞中p21、p53、EGFR、PCNA和CEA的表达,并和胃癌组织及正常胃粘膜组织进行对照。结果　p21对判断细胞的癌变倾向有帮助,而p53仅在癌组织内才有明显表达,EGFR在胃癌组有明显表达,结肠型化生与小肠型化生有显著差异,CEA及PCNA在两型肠化生中的表达无显著差异。结论　结肠型化生较小肠型化生更易发生恶性转换。     

细胞凋亡和细胞增殖在胃癌形成中的作用

目的 :探讨细胞凋亡和细胞增殖在胃癌发生发展中的作用。方法 :用原位末端标记法和免疫组织化学染色 ,检测 30例胃癌和 2 0例胃粘膜上皮异型增生中的细胞凋亡和调控基因 (Bcl 2 ,Fas)及增殖细胞核抗原 (PCNA)的表达情况。结果 :随正常胃粘膜胃粘膜异型增生胃癌的梯度 ,细胞凋亡指数(AI)逐渐降低 ,差异有显著性 (P <0 0 5) ;Bcl- 2的阳性表达率逐渐升高 ,Fas的阳性表达率逐渐降低 ,差异均有显著性 (P <0 .0 1) ,且二者有相关性 (P <0 0 5)。PCNA阳性表达率 (即增殖指数 ,PI)逐渐升高 (P <0 .0 1)。结论 :胃粘膜异型增生中已存在细胞凋亡和细胞增殖的异常 ,使增殖 /凋亡比值加大 ,是胃粘膜异型增生向胃癌发展的重要机制之一     

Expression of HLA-DR and secretory component antigens and lymphocyte infiltration in human gastric nonmalignant and malignant tissues: an immunohistochemical study

The relation between HLA-DR and secretory component (SC) expression and the degree of lymphocyte infiltration was immunohistochemically examined in human gastric mucosa with or without intestinal metaplasia and gastric carcinoma tissues. Gastric mucosa without obvious inflammation showed neither expression of HLA-DR or SC nor remarkable lymphoid infiltration. In contrast, gastric mucosa with chronic inflammation, tissues with incomplete type of intestinal metaplasia, and carcinoma demonstrated both HLA-DR and SC in almost the same area and also prominent lymphoid infiltration in the surrounding stroma. This simultaneous expression of HLA-DR and SC was not observed in complete type of intestinal metaplasia. The results indicate a close relationship between expression of HLA-DR and SC and the presence of lymphocyte infiltration in gastric mucosa, areas of incomplete type of intestinal metaplasia and in gastric carcinomas.     

人体胃液内真菌还原硝酸盐作用的研究及其意义

目的研究人体胃液内所带真菌是否具有还原硝酸盐的作用,从而探讨人类胃癌病因中,真菌因素的可能作用及作用机理.方法对正常8例,浅表性胃炎(CSG)26例,萎缩性胃炎(CAG)22例,胃溃疡(CU)18例,胃癌(GC)19例,共93份胃液进行真菌培养和pH值及硝酸盐、亚硝酸盐含量的测定,并对分离出的真菌进行了还原硝酸盐作用的实验.结果胃液真菌"污染"的情况较严重,不同的pH值范围内,胃液真菌培养的阳性率无明显差异,各种胃病患者的胃液内,真菌的阳性率与正常对照也无差异,但是具有还原硝酸盐作用的真菌的阳性率和胃液中亚硝酸盐的含量,GC组高于CSG组.结论胃内真菌可通过还原硝酸盐为亚硝酸盐而与胃癌有关.     

Clinicopathological study of gastric carcinoma in high- and low-mortality countries: Comparison between Japan and the United States

Background. Gastric carcinoma is a tumor that shows marked differences in geographic distributions. The incidence of the gastric carcinoma has been falling dramatically in Western countries. In sharp contrast, the incidence in Japan is still quite high. Methods. A comparative clinicopathological study was performed, examining gastric carcinomas in 978 Japanese patients (Tokyo) and 157 United States patients (San Diego), that had been surgically resected over the 11-year period 1980–1991. Results. The median age of US the patients (64.1 years) was higher than that of the Japanese patients (59.0 years). There was no difference in the sex ratios. Forty-five of the Japanese patients had early gastric cancer, while this occurred in 10% of the US patients. In terms of tumor location, 47% were in the upper portion of the stomach in the US patients, while, in contrast, this proportion in Japanese patients was 23%. In association with the marked difference in tumor location, 36.5% of the US patients underwent operations with the thoraco-abdominal approach, while this approach was used in 7.5% of the Japanese patients. The distribution of histological types was similar in the two countries' samples. There was also no significant difference in the distribution of the histological types in the same age groups in the two countries' samples. The rate of the well differentiated type increased with age while the rate of poorly differentiated type decreased. In US patients, 35.8% had marked neural invasion, while this occurred in 8.5% of Japanese patients. Conclusion. This study revealed marked differences in the features of gastric cancer between the US and Japan in terms of tumor location and surgical procedures. Received for publication on February 18, 1998; accepted on May 25, 1998     

The role of gastric mucosal dysplasia in the development of Gastric Carcinoma

It is widely acknowledged that most stomach carcinomas developed from dysplastic lesions of gastric mucosa. They can be found in known precancerous conditions as chronic gastritis, gastric adenoma, giant rugal hypertrophy, chronic peptic ulcer, gastric stump after partial resection and pernicious anemia. Several grading systems of gastric dysplasia have been suggested. Nagayo’s or the ISGGC classification was applied to 367 biopsy specimens of 258 patients between 1979–1995. The frequency of moderate and severe dysplasia was 0,84% regarding all gastric endoscopies in the same period of time. Follow-up studies were performed in 56 cases in a period of 1–7 ys. In this group cancer developed during 14 patients. The authors’ recommendation is to follow up the patients gastric dysplasia for least 10 ys after with diagnosis. In memoriam dr. Albert I FIGUS     

近侧胃癌胃裸区受侵及淋巴结转移的手术前判断及临床价值

目的:研究近侧胃癌(PGC)侵犯胃裸区(GBA)的术前诊断及临床意义。方法:回顾性分析37例PGC病人的CT、B超及病理等临床资料,并经手术证实是PGC侵犯GBA,观察其术前影像特征,分析其解剖基础。结果:37例CT及B超表现为肿瘤侵犯GBA内可见不均匀强化的软组织肿块,腹膜后淋巴结肿大或融合成团,左膈肌脚或胃膈韧带不规则增厚并与肿瘤分界不清。结论:PGC侵犯GBA术前能够作出正确判断对于手术方案的制订及术中癌灶的完整切除、相关淋巴结的彻底清扫有重要的临床价值,从而改善PGC的预后。     

不同级别胃黏膜上皮内肿瘤和胃癌组织sFas／mFasmRNA表达比的改变及意义

目的：研究Fas基因的两种拼接异构蛋白基因表达在胃黏膜瘤变形成与发展过程中的变化,在基因水平上探讨Fas系统的表达与胃上皮组织瘤变及免疫逃逸形成的关系,评估胃镜下活检的胃黏膜组织进行Fas基因检测的临床价值和意义。方法：采用半定量RT—PCR法,对胃镜下活检的30例正常胃黏膜组织,30例胃黏膜低级别上皮内肿瘤,20例高级别上皮内肿瘤和30例胃癌组织检测sFas／mFasmRNA表达比。结果：sFas／mFasmRNA表达比在正常胃黏膜组织为0．47±0．07,低级别上皮内肿瘤组织为0．55±0．05,高级别上皮内肿瘤组织为0．22±0．04,胃癌组织为0．19±0．03,正常胃黏膜上皮组织的sFas／mFasmRNA表达比低于低级别上皮内肿瘤（P〈0．01）,低级别上皮内肿瘤sFas／mFasmRNA表达比明显高于高级别上皮内肿瘤组（P〈0．001）,高级别上皮内肿瘤组表达明显高于胃癌（P〈0．001）。结论：正常胃黏膜及瘤变胃黏膜组织FasmRNA以可溶型FasmRNA（sFasmRNA）为主,伴少量的膜型FasmRNA（mFasmRNA）,胃黏膜不同级别上皮内肿瘤和胃癌组织sFas／mFas表达比的强度各不相同,胃黏膜瘤变过程中的Fas基因表达形式具有可修饰性并伴有凋亡易感性的改变,胃镜下Fas基因表达形式的检测,有望指导临床在瘤变发生的早期,即免疫逃逸阶段这一基因水平上提早预知。     

17例胃癌穿孔的诊断治疗体会

目的研究胃癌穿孔患者治疗方法的临床疗效。方法对17例胃癌穿孔的患者进行手术治疗并进行评价。结果治疗后，住院期间死亡率为0；胃肠吻合口瘘为11．8％；平均存活时间为18．3个月；行根治性手术者，平均存活36．2个月。结论对胃癌穿孔患者，只要休克能纠正，身体状态允许，病灶可切除，进行根治性切除治疗是积极的治疗方法。