胃粘膜肠上皮化生的分型及其与胃癌发生的关系

Intestinal Metaplasia Subtypes in Relation to the Development of Gastric Carcinoma

对576例胃粘膜活检肠化标本及85例正常成人及胎儿胃肠粘膜标本进行粘液组织化学染色,将肠化分为3型:Ⅰ型为完全型;Ⅱ和Ⅲ型为不完全型。Ⅱ和Ⅲ型的区别在于后者柱状粘液细胞含有硫酸粘液,而前者则无硫酸粘液。结果表明,Ⅲ型肠化在胃癌及不典型增生组的检出率显著高于其它良性病变组(P<0.05～0.01)。硫酸粘液不仅存在Ⅲ型肠化的柱状细胞,也存在各型肠化的杯状细胞,仅杯状细胞含有硫酸粘液的肠化在胃癌及其它良性胃病粘膜的检出率无显著差异(P>0.05)。以上结果提示,Ⅲ型肠化与胃癌的发生有密切关系,对Ⅲ型肠化定期随访可能有助于胃癌的早期发现。

The relationship between the intestinal metaplasia subtypes and the development of gastric carcinoma (GC) was. investigated with mucohistochemical staining on 576 biopsy specimens taken from patientswith intestinal metaplasia (IM) and 85 specimens taken from gastrointestinal mucosa of normal adults and fetus,IM was classified into 3 types, complete (type Ⅰ) and 2 classes of incomplete (types Ⅱ & Ⅲ) depending on the absence or presence of sulphomucin within the mucin secreting columnar cells. Type III IM was significantly more common in patients with GC and in those with dysplasia than in patients with benign gastric pa,tholgy(P<0.05 -0.001). Sulphomucin was present in columnar cells of type III IM and in the goblet cells of all 3 types of metaplasia. The presence of sulphomucin in goblet cells, however, was not significantly associated with GC.The results suggested that type III IM was closely related to GC, and its identification might be useful in screening patients for early detection of GC.