硫酸粘液分泌的变化在胃癌、结肠癌发生中的意义

目的：通过检测胃粘膜、结肠粘膜癌变过程中硫酸粘液的变化及p53蛋白的表达，寻找有助于胃癌、结肠癌发病高危人群的随访指标，以提高胃癌、结肠癌的早期诊断率。方法：应用粘液组织化学染色高铁二胺一阿尔辛蓝（HID-AB）染色法，对60例慢性胃炎伴肠化、27例胃癌癌旁肠化及35例胃腺癌的胃癌组织，24例正常结肠粘膜，71例溃疡性结肠炎及结肠癌的结肠粘膜组织进行粘液分泌变化分析；应用免疫组织化学染色En Vision两步法，检测胃腺癌、溃疡性结肠炎及结肠腺癌中硫酸粘液阳性组及阴性组p53蛋白的表达。结果：硫酸粘液阳性率在胃粘膜组中，胃腺癌和癌旁肠化（91．43％，92．67%）高于慢性胃炎伴肠化（30％）（P〈0．05）；在结肠癌组织，结肠腺癌（22．41％）低于正常结肠粘膜（91．67％）（P〈0．05）及溃疡性结肠炎（63．38％）（P〈0．05）。p53蛋白的检出率：硫酸粘液阳性胃腺癌（60．40％）高于硫酸粘液阴性组（22．41％）；硫酸粘液阴性结肠癌（53．33％）高于硫酸粘液阳性组（21．43％）；硫酸粘液阴性组p53蛋白阳性率结肠癌（53．33％）高于溃疡性结肠炎（6．67%）（P〈0．05）。结论：（1）胃粘膜出现分泌硫酸粘液的肠上皮化生与胃腺癌的发生关系密切。（2）结肠粘膜中硫酸粘液分泌减少，在癌发生中具有重要意义。（3）对胃癌、结肠癌发病的高危人群（胃粘膜肠化、溃疡性结肠炎患者）随访硫酸粘液分泌变化及p53蛋白的检出，有助于发现早期癌变病例，从而提高胃癌、结肠癌的早期诊断率。

The significance of sulphate mucus secretion in gastric and colonic neoplasia

Objective: To find useful factors in following up the patients with high risk to suffer from gastric and colonic carcinoma, by analyzing mucus secretion and p53 protein expression. Methods: Mucus secretion was analysed by mucinous histochemical staining methods (high-iron diamine-blcian Blue, HID-AB) in 60 cases of chronic gastritis with intestinal metaplasia (IM), 27 cases of gastric mucosa with IM which near carcinoma, 35 cases gastric carcinoma (GC) mucosa, 24 normal colonic mucosa, 71 ulcerative colitis (UC) and 58 cases of colonic carcinoma mucosa, meanwhile the expression of p53 protein was detected by immunohistochemical stain. Results: The positive rate of sulphate mucus was 92.67%, 91.43% in gastric carcinoma and gastric mucosa with IM which near carcinoma, higher than chronic gastritis with IM (30%)(P<0.05); 22.41% in colonic carcinoma, lower than normal colonic mucosa (91.67%) and UC (63.38%) (P<0.05). The positive rate of p53 was 60.4% in sulphate mucus positive GC cases, higher than sulphate mucus negative GC cases (12.5%) (P<0.05); The positive rate of p53 was 53.33% in sulphate mucus negative colonic carcinoma, higher than sulphate mucus positive group. For sulphate mucus negative groups, the positive rate of p53 protein was higher in colonic carcinoma than it in UC. Conclusion: (1) There is significant meaning in IM with sulphate mucus secretion for gastric neoplasia. (2) The decrease of sulphate mucus secretion is related with colonic neoplasia. (3)Sulphate mucus secretion and p53 protein can be used as index in clinical following up the patient with precarcinoma lesions (such as IM in gastric mucus and UC), which may help for finding early neoplasia cases.