癌基因相关分子在胃粘膜良恶性病变中的检测

Detection of Oncogenes and Related Biomoleculars in Benign and Malignant Lesions of Human Gastric Mucosa

目的：探索胃粘膜癌变的病理学指标，为更有效地防治这类病变提供可靠依据。方法：对胃粘膜良恶性病变（共１２０例），用免疫组织化学ＬＳＡＢ法检测生物素化的菜豆凝集素受体（ＰＨＡＲ）、ｐ５３ 蛋白及增殖细胞核抗原（ＰＣＮＡ）的表达。结果：（１）ＰＣＮＡ在正常胃粘膜组阳性率最低，与各组间均有差异（Ｐ＜ ０．０００５），随病变加重而递增。同时，强阳性率在中～重度不典型增生组与腺癌组之间有差异（Ｐ＜ ０．０５）。（２） ｐ５３蛋白在正常胃粘膜、慢性浅表性胃炎活动性（ＣＳＧ）、慢性萎缩性胃炎（ＣＡＧ）、中～重度肠化及轻度不典型增生４组阴性。中～重度不典型增生组及腺癌组阳性，二者间有差异（Ｐ＜ ０．０５）。（３）ＰＨＡＲ阳性率在正常胃粘膜组阴性，随病变程度加重逐步递增，且与各组间均有差异（Ｐ＜ ０．０５）。中～重度不典型增生组与腺癌组在ＰＨＡＲ强阳性率上有差异（Ｐ＜ ０．０５）。（４）腺癌组ＰＨＡＲ、ＰＣＮＡ、ｐ５３蛋白强阳性率三项指标之间有相关性（Ｐ＜ ０．０００５）。结论：ＰＨＡＲ的强阳性表达可作为区分中～重度不典型增生与腺癌的辅助指标。ｐ５３ 蛋白阳性，若同时伴有ＰＨＡＲ强阳性表达，是胃癌的明显标志。

Objiective: To define the risk factors that related to gastric carcinogenesis. Methods: Biotinylated phaseolus vulgaris agglutinin(PHA E+L) proliferating cell nuclear antigene (PCNA) and p53 protein detected in normal gastric mucosa、active chronic superficial gastritis (CSG)、chronic atrophic gastritis(CAG)、moderate severe intestinal metaplasia with mild dysplasia、moderate severe dysplasia gastritic mucosa and adenocarcinoma specimens(20 cases) respectively by means of immuno histochemistry (LSAB). Results: (1) The expression of PHAR was negative in normal nucosa. The more serious the lesion, the higher the positive rates (P<0.05). The strongest positive rate revealed statistic difference between moderate severe dysplasia and adenocarcinoma (P<0.05). (2) p53 protein positive were only found in moderate severe dysplasia and adenocarcinoma, the difference of expression between moderate severe dysplasia and adenocarcinoma was statistically significant (P<0.05). (3) Normal mucosa had the lowest positive rate of PCNA, meanwhile, there were significant differences between this and other five groups (P< 0.0005). Like PHAR, with the advance of lesions, the positive rate raised gradually, and there was statistic difference between moderate severe dysplasia and adeno carcinoma in the strongest positive rate (P< 0.05). (4) In adenocarcinoma group,associations among PCNA、p53 and PHAR were statistically significant (P<0.0005). Conclusion: (1) The overexpression of PHAR can be used to differentiate moderate severe dysplasia from adenocarcinoma. (2) The over expression of p53 protein, especially accompanying PHAR overexpression, should be recognized as a high risk index of gastric carcinoma, even if it can not be identified as an exact cancer case. (3) So far as precancerous lesion is concerned, CAG and moderate severe intestinal metaplasia can be classified as early precancerous lesions.