胃镜下可疑恶变巨大溃疡微观辨证及MG7抗原表达与随访病理对照研究

Contrast study among microcosmic syndrome differentiation,expression of MG-7 Ag and follow up endoscopic biopsy in patients with suspected malignant gastric macro-ulcer

[目的]探讨可疑恶变巨大溃疡胃镜下中医微观辨证分型与胃癌MG7抗原（MG—Ag）表达的关系及两者对良、恶性溃疡鉴别的辅助指导价值。[方法]对58例经首次胃镜检查、活检、病理未能确诊为胃癌的胃巨大溃疡患者进行镜下中医微观辨证分型，同时进行MGT-Ag，ABC免疫组化染色后，临床随访，随访时间1～72周（平均7周），所有患者均再次复查胃镜，组织活检，病理检查。[结果]MG7一Ag阳性表达在络灼伤阴型（18／19）与络阻热瘀型溃疡（8／10）中明显高于胃热型（2／14）与胃寒型（2／15）（P〈0．01）。MG7一Ag阳性表达30例中有19例二次病理活检确诊为胃癌（63．3％），其中络灼伤阴型18例，络阻热瘀型1例；阴性表达28例中有5例确诊为胃癌（17．9％），其中络灼伤阴型1例，络阻热瘀型2例，胃热型与胃寒型各1例。其胃癌检出率在MG7-Ag阳性表达与阴性表达患者之间及不同辨证分型之间差异有统计学意义（P〈0．01）。[结论]MG7一Ag阳性表达络灼伤阴型及络阻热瘀型胃巨大溃疡与胃癌关系密切，对这部分患者进行密切随访，有助于胃癌的早期发现。

[Objective]To study the value of microcosmic syndrome differentiation of gastric macro-ulcer and the expression of MG-7 Ag in diagnosis and instructing follow-up mucosal pathological determination in the patients with suspected malignantt gastric macro-ulcer under gastroscopy. [Methods]The expression of MG-7 antigen in fifty eight patients who were suspected as malignancy gastric ulcer during gastroscopy were detected by ABe immunohistochemical method. These patients were treated with traditional Chinese medicine. The re-examination of gastroscopy and the mucosal pathological determination were performed after followed up for 6 to 72 month. [Results]The positive expression of MGT-Ag in type collaterals burn damaged yin （TCBDY） and type collaterals lock hot stasis（TCLHS）was 18/19 and 8/10 respectively. It was higher than that in type gastric hot（TCH）（2/14） and type gastric cold（TGC） （2/15） （P〈0.01）. Nineteen gastric carcinoma were finally diagnosised out of thirty cases with positive expression of MG7-Ag （63.3%）, only five gastric carcinoma were diagnosised out of twenty night cases with negative expression of MG-7 Ag（17. 9%）（P〈0. 01）. [Conclusion]TCBDY and TCLHS and positive expression of MG-7-Ag are valuable in diagnosing potential subsequent gastric carcinoma in patients with suspected malignancy gastric ulcer under gastroscopy. It is helpful for earlier detection of gastric carcinoma if closely following-up were performed in those patients.