放大内镜联合端粒酶逆转录酶对胃癌前病变的诊断价值

The value of magnifying endoscopy combined with human telomerase reverse transcriptase in diagnosing precancerous gastric lesions

目的探讨放大内镜和人端粒酶逆转录酶(HTERT)在胃黏膜癌前病变中的诊断价值。方法应用放大内镜对154例病人进行检查,放大内镜下做出实时诊断,取活组织分别送病理学检查和实时荧光定量PCR检测HTERT MRNA的表达。放大内镜下胃小凹分为A、B、C、D、E 5型。A型:圆点状小凹;B型:线状小凹;C型:稀疏而粗大的线状小凹;D型:斑块状;E型:绒毛状。结果放大内镜下B^E 4种胃小凹形态肠上皮化生发生率差异有统计学意义(Χ2=17.58,P<0.05),并且肠上皮化生的严重程度逐渐加重(PEARSON列联系数=0.531,P<0.05);C^E 3种胃小凹形态与不典型增生的严重程度关系密切(Χ2=10.256,PEARSON列联系数=0.549,P<0.05);B、C、D、E 4型胃小凹形态间HTERT MRNA表达量差异有统计学意义(F=3.274,P<0.05)。若以胃癌中HTERT MRNA表达量作为胃癌的诊断标准,病理未诊断为胃癌而放大内镜下表现为E型胃小凹的病人中65%符合该标准。结论放大内镜下胃黏膜微细结构形态可反映病变程度的轻重;HTERT是一重要的胃癌标志物,随访E型胃小凹和高HTERT表达的患者有助于早期发现胃癌。

Objective To explore the diagnostic value of magnifying endoscopy and human telomerase reverse transcriptase （hTERT） in identifying precancerous lesions of gastric mucosa. Methods 154 patients with upper digestive symptoms were included in the study, They were examined by the same senior doctor using magnifying endoscopy, and real-time diagnosis was made during the examination. Forceps biopsies were taken for pathological examination and were examined the expression of human telomerase reverse transcriptase mRNA （ hTERT mRNA） by real-time quantitative PCR. The morphology of gastric pits under magnifying endoscopy was classified as follows： type A： round spot pits, type B： linear, type C： sparsely and thickly linear, typed D： patchy, and type E： villous. Results The divergence of intestinal metaplasia had significant differences implications among the gastric pit patterns from B to E under magnifying endoscopy（x^2 = 17.58, P 〈 0.05 ）. The more sever the intestinal metaplasia, the higher the pattern scale of the gastric pit （ Pearson = 0. 531, P 〈 0. 05 ）. The degree of dysplasia had a parallel relationship with the gastric pit patterns changed from C to E （ x^2 = 10. 256, P 〈 0. 05, Pearson = 0. 549, P 〈 0. 05 ）. The expressions of hTERT mRNA of mucosa had significant differences among the gastric pit patterns B, C, D and E（F =3. 274, P 〈0. 05 ） ;ff the expression of hTERT mRNA were taken as diagnostic criteria of gastric cancer, 65% of pit type E would be considered as gastric cancer which were otherwise negative by pathology. Conclusions The micro-structural changes of gastric mucosa under magnifying endoscopy can reflect the severity of gastric disease, hTERT is a very important marker for diagnosis of gastric carcinoma. It is useful to predict the malignant change of gastric precancerous lesions in patients by following up high expression of hTERT mRNA combined with pit type E diagnosed by magnifying endoseopy.