胃癌高发区人群RUNX3表达与胃黏膜病变的关系

Relationship between RUNX3 expression and precancerous gastric lesions in high-risk population

目的:探讨RUNX3蛋白表达与幽门螺杆菌(Helicobacter pylori)感染相关胃黏膜病变的关系。方法:选取山东省临朐县胃癌高发区具有明确胃黏膜病理诊断的1 026例H.pylori感染者为研究对象,采用免疫组织化学方法,检测最高诊断部位胃黏膜组织RUNX3蛋白表达状况。结果:在1 026例患有不同胃黏膜病变的研究对象中,RUNX3表达阳性者为359例,表达率为35.0%(359/1 026),表达率随胃黏膜病变的加重呈逐渐下降趋势,由浅表性胃炎/正常(superficial gastritis/normal,SG/N)的65.6%(40/61)降至异型增生(dysplasia,DYS)的22.4%(60/268,P<0.01)。以SG/N为对照组,RUNX3表达阳性为参照,RUNX3表达阴性者患慢性萎缩性胃炎(chronic atrophic gastritis,CAG)、肠上皮化生(intestinal metaplasia,IM)和DYS的风险分别为表达阳性者的2.83倍[oddsratio(OR)=2.83,95%confidence interval(CI)=1.58～5.06)],3.52倍(OR=3.52,95%CI=1.98～6.24)和7.19倍(OR=7.19,95%CI=3.81-13.56)。进一步分析显示,不论吸烟(或饮酒)状况如何,RUNX3表达阴性者与表达阳性且不吸烟(或不饮酒)者相比,患IM和DYS的风险均明显增加,ORs在2.78～12.29之间。结论:RUNX3蛋白表达水平与H.pylori感染相关胃黏膜病变程度呈明显的负相关,提示RUNX3表达下调可能在胃黏膜病变的演变过程中起重要作用。

Objective：To evaluate the association between RUNX3 expression and Helicobacter pylori （11. pylori）-associated precancerous gastric lesions. Methods： A population-based study was conducted in Linqu County, Shandong Province, a high-risk area of gastric cancer in China. RUNX3 expression was determined by immunohistochemistry analysis in 1 026 H. pylori infected subjects with different gastric lesions. Results： Among I 026 subjects, 359 （35.0% ,359/1 026） was positive. The prevalence rates of RUNX3 expression decreased steadily with severity of gastric lesions, 65.6% （40/61） among those with superficial gastritis/normal （ SG/N）, and 22.4% （ 60/268 ） among those with dysplasia （DYS） （ P 〈 0. 01 ）. Multinomial logistic regression analysis indicated that the risk of advanced gastric lesions were significantly increased for chronic atrophic gastritis [ CAG, odds ratio （OR） = 2.83, 95% confidence in- terval （CI： 1.58 to 5.06）, intestinal metaplasia （IM, OR =3.52, 95% CI： 1.98 to 6. 24） and DYS （OR =7.19, 95% CI： 3.81 to 13.56）] in subjects with negative RUNX3 expression compared with positive. Furthermore, compared to subjects with positive RUNX3 expression and non-smoking （or nondrinking） , significantly increased risk of IM or DYS was observed in subjects with negative RUNX3 expression, the ORs ranged from 2. 78 to 12. 29. Conclusion： Our findings indicate a significantly negative correlation between RUNX3 expression and severity of H. pylori-associated gastric lesions, suggesting that decreased expression of RUNX3 may play an important role in evolution of precancerous gastric lesions.