食管癌病人姐妹染色单体互换和染色体断裂频率变化的初步研究

 本研究发现食管癌病人的SCE基线频率与丝裂霉素C作用下SCE的诱发频率显著高于低发区健康人(P<0.01)和高发区健康人(P<0.01)。高发区健康人的基线SCE频率高于低发区健康人(P<0.01),而诱发频率与低发区健康人比较则无统计学差异。食管癌病人的染色体断裂频率显著高于两组健康群体(P<0.01)。未发现低、高发区健康群体的染色体断裂频率存在差异(P>0.05)。近年来,一些学者对恶性肿瘤病人的姐妹染色单体互换(SCE)频率进行了研究。已发现恶性淋巴瘤、乳腺癌、肝癌、鼻咽癌和宫颈癌病人其外周血淋巴细胞SCE频率增高。对恶性肿瘤时SCE增高的原因尚缺乏一致的看法。我们前已报导了食管癌病人的SCE频率高于正常人。本实验进一步观察了不同群体健康人与食管癌病人的SCE基线频率变化和丝裂霉素C(MMC)作用下SCE诱发频率的变化,并结合分析染色体断裂频率变化与SCE变化的关系。     

盐亭县食管癌病因研究概况

盐亭县开展了食管癌高低发区四季食温对比性研究 ,结果春、冬季高发区平均食温明显高于低发区(P<0.01)。通过对46161例食管上皮细胞正常、增生、癌变时间、癌变率的研究 ,说明食管癌变平均时间重度增生为3年7个月 ,轻度增生为5年4个月 ,正常食管上皮细胞为8年10个月。食管癌变率重度增生为38.8% ,轻度增生为5.8% ,正常食管上皮细胞为1.3%。769例食管癌有癌家族和无癌家族成员进行食管细胞学研究 ,显示食管上皮细胞重度增生和癌变的比例在有食管癌家族成员中显著地高于无癌家族成员(P<0.01)。营养研究说明核黄素营养状况最差(只达标准的39%)。盐亭地区普遍饮用水质不清洁的地面水(92%)。高发区(盐亭)饮水中硝酸盐含量是低发区的3.9倍(P<0.01)。高发区(盐亭)牛、鸡、鼠食管粘膜乳头状瘤、增生均明显高于低发区(成都)。     

食管癌高/低发区食管癌、贲门癌及胃癌检出率比较

[目的]比较食管癌高/低发区食管癌、贲门癌和胃癌检出率,进一步了解遗传和环境因素对食管和贲门癌变的影响。[方法]选择食管癌高发区河北磁县及河南安阳市肿瘤医院就诊患者6864例,低发区河南濮阳市人民医院就诊患者6682例,所有患者均行电子胃镜检查,分析各疾病的检出情况。[结果]高发区食管癌、贲门癌和胃癌分别检出1294例、520例和43例,低发区分别检出482例、165例和146例。高/低发区男性食管癌检出率均高于女性。且高发区食管癌、贲门癌、胃癌的家族史阳性率均显著性高于低发区（P均〈0.05）。[结论]食管癌的发生是环境因素与遗传因素相互作用的结果,探讨高/低发区致癌因素的差异,可为食管及贲门病变的发病机制及预防提供依据。     

贲门不同位点癌前病变情况调查

目的：寻找与贲门癌发生相关的癌前病变。方法：通过对我国食管癌高发区河北省涉县 186例受检者的内镜普查,在贲门区不同位点（贲门脊根部－内镜下 12°点位和对侧－内镜下 6°点位）取活检,进行病理学检查。对比研究我国食管癌高发区河北省涉县居民贲门区粘膜的不同位点上贲门癌发生的差异和癌前病变的差异。进行分组χ 2检验, P< 0.05有显著差异。结果：检出贲门癌 11例。 10例发生在贲门脊根部－内镜下 12°点位占 90.9％, 1例发生在对侧－内镜下 6°点位占 9.01％。贲门区粘膜的不同位点上癌前病变的类型相同,都可为慢性浅表性胃炎、慢性胃炎、慢性活动性胃炎和慢性萎缩性胃炎以及肠化、萎缩和不典型增生;但慢性活动性胃炎在 12°点位检出率明显高于 6°点位, P< 0.05,与贲门癌的检出位点相一致。结论：我国食管癌高发区居民贲门区粘膜的不同位点上癌及癌前病变存在差异;慢性活动性胃炎可能与贲门癌的发生有密切关系。     

食管癌高低发区饮水类型和硝酸盐,亚硝酸盐的测定

本文报道对食管癌高发区和食管癌低发区的饮水调查，饮水类型调查结果说明高发区金价水质量差，低发区饮水擀好，高发区饮地下水者明显少于低发区。高低发区水质测定结果说明高发区饮水中硝酸盐和亚硝酸盐含量均明显高于低发区。     

广西扶绥县肝癌高发区和相对低发区儿童黄曲霉毒素B1摄入量对比研究

对广西扶绥县肝癌高发区和相对低发区385例5～13岁儿童的黄曲霉毒素B_1(AFB_1)摄入量进行了对比研究,结果表明,肝癌高发区儿童AFB_1摄入量明显大于相对低发区儿童(P<0.01),分别为123.51ng/kg体重/日和30.58ng/kg体重/日,前者是后者4倍多;同时,高发区儿童24小时尿中黄曲霉毒素M_1(AFM_1)排出量亦高于相对低发区儿童,分别为2.71ng/kg体重/日和1.00ng/kg体重/日(P<0.01),前者是后者两倍多。研究结果提示,该县境内出现肝癌高发区和相对低发区之差别,原因之一是不同地区居民从儿童时期起暴露于AFB_1水平不同,肝癌高发区是AFB_1高摄入量区。因此,从儿童时期起就开始注意减少AFB_1摄入量,对预防原发性肝癌有十分重要意义。     

高、低发区食管癌患者淋巴结转移及其影响因素与生存期的关系北大核心CSCD

目的探讨高、低发区食管癌患者淋巴结转移影响因素及其对生存期的影响,并对新版食管癌TNM分期进行评价。方法通过入户或电话问卷调查进行生存随访,采用卡方检验、二元Logistic回归,Kaplan-Meier生存曲线和Log rank检验及Cox生存分析模型,分析高、低发区食管癌患者淋巴结转移影响因素及与生存期的关系。结果淋巴结转移阳性食管癌患者(n=5 621)的生存期明显低于转移阴性患者(n=7 945)(P=1.9E-162),N1、N2和N3级食管癌患者生存期依次明显降低(P=4.2E-20)。在淋巴结转移阳性率上,高发区患者明显高于低发区(P=1.4E-5),但生存期却优于低发区(P=1.7E-39);青年食管癌患者(≤50岁)略高于中老年患者(>50岁)(P=0.003),而生存期显著优于中老年患者(P=2.3E-31);下段食管癌显著高于中段和上段(P=8.6E-24),而生存期则明显优于中段和上段(P=0.03)。多因素分析,高低发区、性别、诊断年龄、肿瘤部位、分化和浸润程度是影响食管癌患者淋巴结转移和生存期的独立因素,N1、N2和N3级患者生存期差的风险值依次升高(HRN1=1.8,HRN2=2.5,HRN3=2.7)。结论淋巴结转移阳性患者生存期显著差于转移阴性的患者;随着淋巴结转移个数增多,食管癌患者生存期明显降低;高发区患者整体生存期优于低发区患者。     

食管鳞癌分化程度与淋巴结转移的关系

目的：分析食管癌高低发区食管鳞癌患者分化程度与淋巴结转移的关系。方法14335例食管鳞癌患者临床病理信息均来自河南省食管癌重点开放实验室食管癌资料库,其中高发区7007例、低发区7328例;所有患者均经手术治疗,并详细记录患者术后病理,包括分化程度和淋巴结转移等。结果高发区和低发区食管鳞癌患者均以中分化为主（48% vs 61%）,低分化和高分化次之,未分化最少（0.6% vs 0.4%）。高发区男性患者40~49岁和50~59岁年龄组高分化率明显高于同年龄组低发区患者（ P 〈0.05）;但高发区女性患者仅40~49岁年龄组高分化率明显高于同年龄组低发区患者（ P〈0.05）。特别值得指出的是：高发区（ r=0.125,P〈0.05）和低发区（ r=0.105,P〈0.05）患者分化程度与淋巴结转移显著相关。结论高低发区食管鳞癌患者均以中分化为主;高发区男性和女性40~49岁年龄组高分化率均明显高于同年龄组低发区患者;分化程度与淋巴结转移关系密切,分化程度越差,淋巴结转移阳性率越高。     

胃癌高发区土地岔乡居民幽门螺旋菌感染的研究

 本文对我室于1990年8月在陕北胃癌高发区土地岔乡进行胃癌普查中的325例自然人群胃粘膜活检标本作了幽门螺旋菌(HP)检测的研究.结果显示:该乡居民HP检出率较高(66.77%),并以50~59岁年龄组为高;HP检出部位以胃窦部为多(65.54%);HP检出率随慢性胃炎病变的进展而增高(慢性浅表性胃炎为64.35%;慢性萎缩性胃炎为79.31%;慢性胃炎伴肠化生为82.05%,伴异型增生为86.67%;慢性活动性胃炎为94.79%).这些特征都与本地区胃癌的发生特征相一致.从而提示,胃癌高发区居民HP感染应视为与胃癌发生相关的致病因素,亦为影响慢性胃炎发生发展的一种重要致病因素.     

食管癌高低发区人群尿互隔交链孢霉素排出水平的研究

本文报道了薄层层析法(TLC)和高效液相色谱法(HPLC)对食管癌高低发区人群尿中互隔交链孢霉毒素的测定结果,从高发区40例尿液中检出7例阳性,阳性率为17.5％。最高含量AME为5.476μg/夜尿,AOH为12.813μg/夜尿。低发区商丘和郑州市各20例中均未检出。结果表明,高发区人群尿排出水平高于低发区,食管癌的发生可能与摄入互隔交链孢霉毒素有重要关系。     

胃癌高低发区居民空腹胃液中N—亚硝酰胺总含量的比较

Ｎ－亚硝酰胺（ＮＡＤ）为高度可疑的人胃癌病因,但缺乏直接的流行病学证据。本研究探讨了ＮＡＤ暴露与人胃癌流行的相关性。方法利用胃液痕量ＮＡＤ总量分析和胃镜活检等技术,对胃癌高发区山东省临朐县和低发区苍山县３５～６８岁居民空腹胃液中ＮＡＤ暴露水平进行比较。结果（１）高发区样品ＮＡＤ的阳性率（ｎ＝１７６,４０．９％）高于低发区（ｎ＝９９,３０．３％）,经标化后有统计学意义（ｐ＝０．０３２４）。（２）在高发区仅４８％胃液样品的ｐＨ≤３,而在低发区则高达８４％（ｐ＜０．００１）;在ｐＨ≤３的样品中,ＮＡＤ的阳性率也是高发区高于低发区（４６．２％比２７．４％,ｐ＜０．０１）;在低发区样品中,ｐＨ值高者ＮＡＤ的阳性率高于ｐＨ值低者,在高发区则无此现象。（３）慢性缩性胃炎（ＣＡＧ）和ＣＡＧ伴异型增生者,胃液ＮＡＤ的阳性率高于胃粘膜正常和浅表性胃炎者。结论本研究揭示,ＮＡＤ的暴露与胃癌的流行可能存在正相关关系,ＣＡＧ和异型增生与ＮＡＤ致胃癌过程关系密切。     

Chronic post-treatment symptoms in patients with breast cancer operated in different surgical units.

AIMS: This study was designed to find out whether women operated in high volume surgical units have less chronic symptoms than women operated in smaller volume units. METHODS: A questionnaire was sent to 265 consecutive women treated at the Department of Oncology, Helsinki University Central Hospital, from January to June 1996. Of the patients, 129 were operated in hospitals experienced in breast cancer surgery (high volume units = HVU) and 92 patients in district hospitals with less experience in breast surgery (low volume units = LVU). RESULTS: Chronic symptoms were less common in HVU than in LVU: chronic pain (56 vs. 43%, P<0.05) or strange sensations (45 vs. 26%, P<0.01) in the ipsilateral arm or phantom sensations in the removed breast (66 vs. 26%, P<0.001). The risk factors included in the multivariate model for chronic pain in the breast area were: intensity of acute post-operative pain, radiotherapy and depression and for the chronic arm pain: low volume unit and depression. CONCLUSIONS: More careful surgical technique seems to reduce the risk of chronic pain following treatment of breast cancer. Chronic pain is associated with more intense post-operative pain and depression.     

Helicobacter Pylori Associated Gastritis Increases Risk of Colorectal Polyps: a Hospital Based-Cross-Sectional Study in Nakhon Ratchasima Province,Northeastern Thailand

Background: Colorectal polyps are common in Thailand, particularly in the northeastern region. The present study aimed to determine any correlation between Helicobacter pylori-associated gastritis and colorectal polyps in the Thai population. Materials and Methods: A total of 303 patients undergoing esophagogastroduodenoscopy with colonoscopy for investigation of chronic abdominal pain participated in this study from November 2014 to October 2015. A diagnosis of Helicobacter pylori associated gastritis was made if the bacteria were seen on histopathological examination and a rapid urease test was positive. Colorectal polyps were confirmed by histological examination of colorectal biopsies. Patient demographic data were analyzed for correlations. Results: The prevalence of colorectal polyps was 77 (25.4%), lesions being found more frequently in Helicobacter pylori infected patients than non-infected subjects [38.4% vs. 12.5%; Odds Ratio (OR) (95% CI): 2.26 (1.32 - 3.86), p < 0.01]. Patients with Helicobacter pylori - associated gastritis were at high risk of having adenomas featuring dysplasia [OR (95% CI): 1.15 (1.16 - 7.99); P = 0.02]. There was no varaition in location of polyps, age group, sex and gastric lesions with respect to Helicobacter pylori status. Conclusions: This study showed that Helicobacter pylori associated gastritis is associated with an increased risk of colorectal polyps, especially adenomas with dysplasia in the Thai population. Patients with Helicobacter pylori-associated gastritis may benefit from concurrent colonoscopy for diagnosis of colorectal polyps as a preventive and early treatment for colorectal cancer.     

454例自然人群的3432份胃粘膜活检观察

自胃癌高发区454例自然人群的3432份胃粘膜活检,检出胃癌5例,慢性浅表性胃炎(CSG)67.28％,慢性萎缩性胃炎(CAG)3.88％,肠上皮化生(IM)14.28％。CSG在胃体部高于窦部,CAG与IM则胃窦部明显高于体部(P<0.05)。支持CAG、IM为癌前状态之观点。     

CAMPYLOBACTER-PYLORIDIS INFECTION OF GASTRIC MUCOSA IN THE HIGH AND LOW RISK AREAS OF STOMACH CANCER IN CHINA

Gastric biopsies in 690 subjects from the high and low risk areas of gastric cancer were examined for identification of Cp in the gastric mucosa by Warthin-Starry, Gimenez and Gram' s stains. The result showed that the positive rate was 60-62% in the high risk area whereas it was only 12. 6% in the low risk area in Liaoning province. 80-92% of the positive subjects had active chronic gastritis including chronic superficial and atrophic gastritis. The result Indicates a close correlation between the active chronic gastritis and Cp infection. Therefore, control of the Cp Infection in the gastric mucosa is very important for lowering the incidence of chronic gastritis, a well known precursor of gastric cancer.     

Campylobacter pyloridis (Cp) infection of gastric mucosa in the high and low risk areas of gastric cancer in Liaoning province

Gastric biopsies in 690 subjects from the high and low risk areas of gastric cancer were examined for identification of Cp in the gastric mucosa by Warthin-Starry, Gimenez and Gram's stains. The result showed that the positive rate was 60-62% in the high risk area whereas it was only 12.6% in the low risk area in Liaoning province. 81-85% of the positive subjects had active chronic gastritis including chronic superficial and atrophic gastritis. The result indicates a close correlation between the active chronic gastritis and Cp infection. Therefore, control of the Cp infection in the gastric mucosa is very important for lowering the incidence of chronic gastritis, a well known precursor of gastric cancer.     

幽门螺旋杆菌感染胃黏膜COX-2和P-gp表达与胃癌发生

背景与目的通过检测幽门螺旋杆菌(Helicobacter Pylori,H.pylori)感染胃粘膜组织环氧合酶-2(Cyclooxygenase-2,COX-2)和多药耐药-1(Multidrug resistance-1,MDR-1)基因表达产物P糖蛋白(P-glycoprotein,P-gp)表达,探讨幽门螺旋杆菌相关胃癌的发生机制,以及P-gp高表达的机制。材料与方法慢性胃炎155例(30例慢性浅表性、40例慢性萎缩性、45例肠化、40例非典型增生)及胃癌80例(肠型40例,弥漫型40例),COX-2和P-gp表达检测选择免疫组化S-P法,H.pylori感染检测采用快速脲素酶及改良Giemsa染色方法。结果H.pylori阳性感染率、COX-2和P-gp的阳性表达率,肠型胃癌均明显高于弥漫型胃癌(P<0.01)。慢性萎缩性胃炎、肠化、非典型增生及肠型胃癌中H.pylori感染与COX-2的表达呈正相关(P<0.01)。H.pylori感染的慢性浅表性胃炎、慢性萎缩性胃炎、肠化、非典型增生及肠型胃癌中COX-2的表达与P-gp的表达也均呈正相关(P<0.01)。结论H.pylori依赖的COX-2表达与P-gp表达有关,可能有助于胃癌形成以及胃癌对化疗抵制。     

Cyclooxygenase-2 expression in chronic gastritis and gastric carcinoma, correlation with prognostic parameters

BACKGROUND: Cyclooxygenase-2 (Cox-2) is the inducible form of cyclooxygenase enzyme. Cox-2 is induced in numerous processes such as cellular growth, differentiation, inflammation and tumorogenesis. PURPOSE: Assessment of Cox-2 expression in chronic gastritis and gastric carcinoma. MATERIAL AND METHODS: Sixteen chronic gastritis (CG) and 43 gastric carcinoma cases were subjected to an immunohistochemical approach using anti Cox-2 antibody. RESULTS: All CG cases displayed positive epithelial Cox-2 expression with only 25% positivity for stromal expression. Eighty six percent of gastric carcinoma showed epithelial Cox-2 expression that was significantly correlated with lymph node involvement (p<0.01), advanced stage (p=0.01), high microvessel density (MVD) (p=0.0001), vascular invasion (p=0.002), perineural invasion (p=0.01) and low apoptotic count (p<0.0001). Stromal Cox-2 expression was seen in 79% of gastric carcinoma cases and was significantly associated with low apoptotic count (p=0.0007), vascular invasion (p=0.001) and high microvessel density (MVD) (p=0.0003). Only stromal Cox-2 expression was significantly higher in gastric carcinoma than chronic gastritis (p=0.0001). CONCLUSIONS: Cox-2 appears to be involved in gastric carcinoma progression as it promotes angiogenesis, suppresses apoptosis and facilitates invasion and metastasis. Double expression of Cox-2 in gastric carcinoma epithelium and stroma and significant association between them demonstrate a paracrine cross effect between stromal and malignant epithelium.     

bFGFR、COX-2和MVD在胃癌中的表达及其与浸润转移的关系

目的 探讨碱性成纤维生长因子受体（bFGFR）、环氧合酶-2（COX-2）和微血管密度（MVD）与胃癌浸润、转移的关系。方法 选择80例手术切除的胃癌标本为观察组,40例慢性浅表性胃炎为对照组,应用免疫组织化学方法检测组织中bFGFR、COX-2和MVD的表达情况。结果 bFGFR及COX-2在胃癌患者中的阳性率为50.0%和52.5%。在对照组的阳性率分别为5.0%和0,差异均有统计学意义(P<0.01)。MVD在胃癌及对照组中的表达分别为（46.9±2.2）和（26.2±2.3）,差异有统计学意义（P<0.01）。三者的表达与肿瘤的浸润、淋巴及远处转移呈正相关(P<0.01或P<0.05),与肿瘤大小、分化程度无关(P>0.05)。bFGFR阳性和COX 2阳性组MVD值（48.7±10.2、49.6±11.6）均高于bFGFR阴性和COX-2阴性组（33.6±5.2、32.7±4.5,P<0.01）。bFGFR与COX-2的表达呈正相关（γ=0.700,P=0.0000）,二者在胃癌组织中的阳性表达强度与淋巴、远处转移呈正相关（P<0.01）。）结论 胃癌组织中bFGFR、COX-2和MVD的表达与胃癌的浸润、转移密切相关,三者在肿瘤血管形成中可能存在相互协同作用。三者的阳性表达可作为胃癌生长,转移的重要判定指标。     

热休克蛋白70在人胃癌中呈过度表达

目的：研究热休克蛋白７０（ＨＳＰ－７０）在人胃癌组织中的表达。方法：应用抗人ＨＳＰ７０单克隆抗体对１９０例手术及胃镜活检胃癌及非癌胃粘膜病变石蜡标本,以免疫组织化学ＡＢＣ法检测ＨＳＰ７０的表达。结果：ＨＳＰ７０在胃癌、慢性浅表性胃炎、肠上皮化生及不典型增生组织中的阳性率分别为７３％、３２．５％、６６％及７２％;地表达率分别为５６％、５．８％、２９．２％及３３．３３％。ＨＳＰ７０在肠上皮化生、不典型