Lugol液染色对食管早期癌和癌前病变的诊断价值

目的 探讨Lugol液染色对食管早期癌和癌前病变的诊断价值。方法 对45例食管黏膜可疑病变经内镜以2％Lugol液喷洒染色，观察黏膜染色情况，并取活检送病理组织学检查。结果 45例食管病变染色后，39例呈浅染色或不染色，其中食管癌8例（食管早期癌5例，进展期癌3例），Barrett食管5例，轻至中度不典型增生1l例。本组Lugol液染色对食管早期癌和癌前病变的检出率达46．7％。结论 内镜下应用Lugol液染色结合活检有助于食管早期癌和癌前病变的诊断，且操作简便，具有重要的临床价值。     

门脉高压性胃病患者的胃壁血气变化

作者观测了４３例门脉高压症患者股动脉血ＰＯ２、胃网膜有动静脉胃壁支血ＰＯ２、胃壁支静脉及肘静脉血ｐＨ、ＨＣＯ３－和胃网膜右静脉压力，其中２３例并有非出血期门脉高压性胃病。结果表明：①门脉高压症患者的股动脉血ＰＯ２低于对照组；②门脉高压症患者胃网膜右动静脉胃壁支血氧分压差低于对照组，胃网膜右静脉压力高于对照组，胃壁支静脉血ｐＨ和ＨＣＯ３－低于对照组和同组肘静脉血。并有门脉高压性胃病者这些变化更为显著。提示门脉高压性胃病的发病机制在于门脉系压力增高、胃粘膜下动静脉短路开放、胃粘膜缺血缺氧和胃壁局部酸中毒。     

胃幽门弯曲菌感染对胃癌发生影响的探讨

应用Warthin-starry镀银技术检查胃幽门弯曲菌,对中国胃癌高发区及美国胃癌高发区新奥尔良检查了300例具有胃症状的胃粘膜标本。结果发现幽门弯曲菌阳性率为60～62%,并且看到这种细菌的感染与慢性胃炎病变的程度有明显的关系。本文探讨了幽门弯曲菌的感染与胃癌癌前病变的关系。     

核仁形成区嗜银蛋白定量对结肠癌前病变的监测作用

应用银染技术,对24例结肠腺癌Ⅱ级不典型增生,30例绒毛状腺瘤,14例绒毛状腺瘤Ⅲ级不典型增生和29例高分化管状腺癌进行银染核仁形成区嗜银蛋白(Ag-NORs)定量研究,观察Ag-NORs数量、形态、大小和分布在结肠肿瘤交界性病变中的表达.提示Ag-NORs四项指标定量研究对结肠脉瘤,特别是Ⅲ级不典型增生与绒毛状腺瘤之结肠癌前病变有较好的监测作用.     

胃粘膜癌变过程中P1 6、CyclinD1的表达

目的：探讨Ｐ１６、ＣｙｃｌｉｎＤ１的表达在胃癌发生发展中的作用。方法：采用免疫组化Ｓ－Ｐ法。结果：在胃粘膜癌变过程中，Ｐ１６阳性表达率逐渐下降，其中异型增生和胃癌组Ｐ１６阳性表达率明显低于慢性浅表性胃炎组（Ｐ　＜０．０５）；ＣｙｃｌｉｎＤ１阳性表达率逐渐增高，其中肠化生、异型增生和胃癌组ＣｙｃｌｉｎＤ１阳性表达率明显高于慢性浅表性胃炎组（Ｐ　＜０．０５）。在胃癌中，Ｐ１６阳性表达率与胃癌分期和分化程度有关，ＣｙｃｌｉｎＤ１的阳性表达率与之无关。结论：Ｐ１６表达缺失和ＣｙｃｌｉｎＤ１异常表达是胃癌发生过程中一个较早的分子事件，且Ｐ１６表达缺失与胃癌进展和恶性程度有关。     

前列腺癌及其癌前病变的细胞核形态特征与DNA含量的定量研究

应用计算机图像分析技术，对３０例前列腺癌（ＰＣ）和３０例前列腺非典型增生（ＰＤ）的石蜡包埋标本进行了核形态定量参数、ＤＮＡ含量的定量测定。结果显示：ＰＤ的核面积明显高于正常细胞而低于ＰＣ（Ｐ＜０．０１）。三级ＰＤ之间，两两相比有非常显著性差异（Ｐ＜０．０１）。ＰＤ３与ＰＣ１的核面积有明显交叉，说明ＰＤ３具有ＰＣ的某些特征。正常前列腺上皮细胞与ＰＤ细胞核ＤＮＡ含量及倍体分布近似。ＰＤ１～ＰＤ３细胞核ＤＮＡ含量均值呈递增现象。ＰＣ组织分化程度越低，细胞核ＤＮＡ含量增高越显著，２Ｃ和４Ｃ细胞越少，呈明显相关关系。提示ＤＮＡ含量变化与前列腺癌和癌前病变的细胞分化异常密切相关。     

Tissue zinc levels in precancerous tissue in the gastrointestinal tract of azoxymethane (AOM)-treated rats

Alterations in tissue zinc levels have been documented in patients with gastrointestinal tract malignancies and more frequently, in those with colonic cancer. However, the precise role of tissue zinc in carcinogenesis is not well elucidated. This study, using a well-established colon cancer model in rats, was designed to investigate the relationship of tissue zinc to the carcinogenic process. The aim was to examine tissue zinc levels in the preneoplastic tissues and to study the changes that occur during transition of mucosa from normal to preneoplastic state. Six-week old rats were given a single dose subcutaneous injection of azoxymethane (AOM) (30mg/kg body weight) and sacrificed after 1, 2, 5, and 9 months of the treatment. Plasma zinc levels showed a significant decrease (p<0.05) at 9 months compared with controls. Tissue zinc levels showed a significant decrease in the large intestine at 1 and 2 months (p<0.05) and at 5 and 9 months (p<0.01), in the small intestine at 2, 5, and 9 months (p<0.05), and in the stomach at 5 and 9 months (p<0.05). The maximum percent decrease (45%) in tissue zinc was observed in the large intestine at 9 months. Tissue copper zinc super oxide dismutase (CuZnSOD) activity was assessed in the body of the stomach, small intestine, and large intestine and compared with the control group. There was a significant fall in CuZnSOD levels in the small intestine at 9 months (p<0.05) and in the large intestine at 5 and 9 months (p<0.01). Two of these six rats showed histological evidence of precancerous lesions in the mucosa of the colon. This study suggests that the decrease in plasma zinc, tissue zinc and activity of CuZnSOD is associated with development of preneoplastic lesions in the colonic mucosa.     

大肠腺瘤三维结构的临床病理研究

我们应用三维结构（３－Ｄ）再构成计算机系统，以０．２ｍｍ间隔连续切片，ＨＥ染色，对５０例经纤维结肠镜切除的大肠腺瘤各种异型上皮的体积及分布规律进行研究。其中癌变１７例（３４％），其平均体积是单纯腺瘤的３．４倍。腺瘤体积越大，其癌变率越高，但体积较小的亚有蒂型腺瘤也有很高癌变率（２５％）。研究结果表明腺瘤体积大小与平均异型度无相关关系。用常规方法切片，仅检出１４例有癌变，漏诊率１８％。为提高腺瘤癌变检出率，至少应以０．６ｍｍ间隔连续切片。此种方法对准确判定断端有无癌浸润也有重要意义。     

Dysplasia in the gastrointestinal tract: definition and clinical significance

Summary The term dysplasia is used increasingly in gastrointestinal pathology. Dysplasia denotes an unequivocal neoplastic epithelial alteration without invasive growth and is synonymous with the term intraepithelial neoplasia. Dysplasia is the paradigm of a precancerous lesion. Confusion arises because some pathologists do not use the term in the above-defined sense but to describe regenerative, inflammatory and reactive changes. It is essential to separate these kinds of non-neoplastic epithelial changes from neoplastic dyplasia because the clinical consequences are completely different. The general morphology and the grading of dysplasia are described. Most dysplasias in the gastrointestinal tract are the polypoid lesion; dysplasias in flat mucosa are uncommon. Knowledge of the incidence of dysplasia in the gastrointestinal tract is important for the concept of secondary cancer prevention.     

FAM19A4基因启动子甲基化检测在宫颈癌及其癌前病变筛查的研究

宫颈癌是最常见的妇科恶性肿瘤之一。目前人乳头瘤病毒(HPV)检测及细胞学检查是宫颈癌及其癌前病变(CCPL)的主要筛查手段。由于上述传统筛查方法,仍然存在对CCPL漏诊的风险,因此寻找有效识别CCPL的特异性分子标志物,具有重要临床意义。对具有序列相似性家族19成员A4(FAM19A4)基因启动子甲基化定量检测,可有效检出CCPL组织,较传统筛查方法有较高特异度,有望成为CCPL筛查的特异性分子标志物。笔者拟就FAM19A4基因启动子甲基化定量检测,在CCPL筛查中应用的最新研究现状进行阐述,旨在为进一步推进CCPL筛查方法的开发,提供思路。