胃粘膜肠化生细胞增值状态分型的研究

Study of Cell Proliferation Typing in Intestinal Metaplasia of Gastric Mucosa

应用免疫组织化学方法检测230例胃粘膜病变中增殖细胞核抗原（PCNA）的表达情况，计算细胞增殖指数（PI）、探讨胄粘膜肠化生的增殖状态分型以及肠化生细胞增殖分型与肿瘤相关基因蛋白产物的关系。结果显示正常或慢性浅表性胃炎、伴肠化生慢性萎缩性胃炎、伴异型增生萎缩性胃炎以及胃腺癌的PI逐渐增高，差异非常明显（P＜0．0）。根据胃粘膜肠化生细胞的PI分布，进行畅化生细胞的增殖状态分型：高增殖状态型为PI≥40，中增殖状态型为20≤P＜40，低增殖状态型为PI＜20。此分型与各类胃粘膜病变显示较好的相关性，低增殖状态型为正常或基本正常胃粘膜，中增殖状态型为胃粘膜良性病变，高增殖状态型为胃粘膜癌前病变。高增殖状态型肠化生中肿瘤相关基因蛋白产物rasp21、EGFR、h-met的表达以及叵型肠化生的检出率显著高于中、低增殖状态型肠化生（P＜0．05）。提示高增殖状态型肠化生细胞基因表达的异常率增高，且细胞分化不良，更具胃癌前病变的特征。

By using S-P immunohlstochernical method, the expresslon of proliferatlng cell nuclear antigen(PCNA) and the cell proliferatlon index (PI) were measured in 230 patients with gastric lesions to study the correlation of the staging of cell proliferation status and cell proIiferatlon of intestlnal metaplasia in gastric mucosa with the tumor related gene products. The results showed that the difference of PI between nornlal mucosa, lntestinal metaplasia, dysplasia and gastric carcinoma was highly significant (P<0.01). On the basis of Pl distribution of metaplastic cells in the gastric mucosa, the proliferation status of intest1nal metaplasia was typed as: hlghly proliferatlve type,and the limits of PI in these types were PI≥40, PI≤40, Plwt 20 respectively. The intestlnaI metaplasla in highly proIiferative type showed a most abnormal expressIon of ras p21, EGFR and h-met. It is suggested that the cell proliferation typing in intestinal metaplasia of gastric mucosa is an effective index to evaluate the outcome of lntestinal metaplasia.