肝细胞蛋白在肠上皮化生型Barrett食管中的诊断价值

The diagnostic value of hepatocyte in the intestinalized mucosa of Barrett's esophagus

目的 比较肝细胞蛋白、细胞角蛋白7、细胞角蛋白2 0、上皮膜抗原(EMA) 4种蛋白在Barrett食管化生的肠上皮中表达的差异。方法 采用免疫组化SP法检测2 3例肠上皮化生型Barrett食管标本中肝细胞蛋白、细胞角蛋白7、细胞角蛋白2 0、EMA四种蛋白的表达,同时进行爱先蓝高碘酸 无色品红[AB(pH2 .5 ) PAS]染色标记,比较表达的差异。结果 化生的肠上皮中均可见肝细胞蛋白、细胞角蛋白7、细胞角蛋白2 0及AB(pH2 .5 ) PAS染色的阳性表达;肝细胞蛋白在所有肠化上皮细胞胞质中表达,胃及肠上皮均不表达;细胞角蛋白2 0、细胞角蛋白7在肠化上皮细胞胞质、部分胃柱状上皮中呈阳性表达;EMA在小肠及肠化上皮以外的其他上皮均有表达;AB(pH2 .5 ) PAS染色蓝染部分仅为肠上皮杯细胞中的黏液,其余的胃上皮细胞显示红色,鳞状上皮不显色。结论 肝细胞蛋白可作为特异性标记化生肠上皮的首选指标,细胞角蛋白2 0、细胞角蛋白7亦是肠上皮化生的敏感指标,但特异性不强;AB(pH2 .5 ) PAS及EMA在显示肠上皮化生方面不具有优势。

Objective To compare the expressional differences of hepatocyte, cytokeratin 7, cytokerati n 20,epithelial membrane antigen (EMA) in the intestinalized mucosa(IM) of Barre tt's esophagus. Methods Streptavidin-peroxidase (SP) immunohistochemical staining method was applied to dete ct the expressions of protein hepatocyte, cytokeratin 7, cytokeratin 20 and EMA in 23 cases of Barrett's esophagus with IM, whilst Alcian blue(pH2.5)-Periodic acid schiff[AB(pH 2.5)-PAS] staining was also conducted. The expressional differences in IM among the above four proteins and the special staining were evaluated. Results The expressions of hepatocyte, cytokeratin 7, cytokeratin 20 and AB(pH2.5)-PAS were all observed in Barrett's IM. Hepatocyte was expresse d in the cytoplasm of the whole IM, while the rest of the epithelia were negativ e. Cytokeratin 7 and Cytokeratin 20 were expressed in most IM and partial gastr ic type columnar epithelium. EMA was expressed in all the epithelia except the s mall intestine and IM. Only the goblet cells were stained blue with AB (pH2.5) -PAS, whilst the rest of the gastric epithelial cells were stained red, with no sta ining in the squamous cells. Conclusion Hepatocyte could serve as the preferred marker for int estinal metaplasia, cytokeratin 7 and cytokeratin 20 were also sensitive but les s specificity, whilst AB (pH2.5)-PAS and EMA had no advantage in displaying the intestinalized mucosa.