胃黏膜上皮异型增生3～10年随访结果

目的探讨胃黏膜上皮异型增生自然转归的规律及与胃癌的关系,为临床处理异型增生病灶提供依据和方法。方法选取1994-01～2001-12经胃镜检查及病理确诊的异型增生患者82例,进行了3～10年的胃镜随访,其中63例采用免疫组化法检测了端粒酶活性,观察不同程度的异型增生的变化规律和可能的影响因素。结果82例异型增生患者,轻度异型增生54例,中度异型增生19例,重度异型增生9例。异型增生灶位于胃窦部最多43个。异型增生灶外观各异,以糜烂最常见28个,次之溃疡24个,黏膜粗糙13个,息肉8个熏黏膜灰白5个,纹理紊乱4个。轻度异型增生病变消失率最高,达87.04%,但也有3.70%发生癌变,重度异型增生癌变率最高,达44.44%熏但也有33.33%发生逆转,中度异型增生的消失率和癌变率则介于轻、重度之间,轻、中、重度异型增生的端粒酶阳性率分别为11.43%穴4/35雪、21.05%穴4/19雪、66.67%穴6/9雪。结论不同程度的异型增生均有一定的癌变能力,随异型增生程度的加重,其端粒酶阳性率及癌变率亦相应增高,临床上对异型增生的处理应根据异型增生的不同程度区别对待。

A follow-up of 3-10 years for 82 cases of gastric mucose- epithelium dysplasia

Objective Through investigating the natural turnover of gastric mucose- epithelium dysplasia and the relation of it with the stomach cancer,to provide the basis and the method of clinical procedures for the dysplasia. Method The 3-10 years follow-up study was carried out for 82 cases with gastric epithelium dysplasia definited by gastroscopy and pathology,of the 82 cases telomerase activity 63 cases were detected by using Immuno- histochemistry method.Results Among the 82 cases of dysplasia,there were 54 with mild dysplasia lesion,19 with moderate dysplasia lesion,and 9 with severe dysplasia lesion.The gastric epithelium dysplasia lesions were mainly located in sinus ventriculi,and its endoscopic appearance were different:anabrosis was common,ulcer was secondary,another dysplasia lesions included rough mucosa,grayish-white mucosa,texture derangement and polypus.The disappearance rate of mild dysplasia lesions was 87.04%,canceration rate was 3.70%,but canceration rate in severe dysplasia lesions was 44.44%.The positive rate of telomerase in mild dysplasia was 11.43%(4/35),in moderate dysplasia was 21.05%(4/19),and in severe dysplasia was 66.67%(6/9).Conclusion There is cancerization in any degree for gastric epithelium dysplasia lesions,carcinomatous evolution of gastric epithelium dysplasia increases proportionally with its histological grade.The telomerase activity may be related with cancerization.Gastroscopy biopsy and effective treatment should be taken for all grades of dysplasia in time.