CK7、CK20及CDX2在不同病理类型Barrett食管中的表达及意义

Expression and significance of CDX2,CK7 and CK20 in Barrett's Esophagus

目的分析CK7、CK20及CDX2在不同病理类型Barrett(BE)食管中的表达意义,探讨3种不同组织病理类型的BE食管在分子生物学方面的变化。方法选取病理诊断明确的胃底型BE组22例,贲门型BE组20例,特殊肠化型BE组18例。应用免疫组化法检测不同类型BE食管黏膜组织中CK7、CK20及CDX2的表达率及表达强度,并以正常食管黏膜、正常贲门黏膜及反流性食管炎作为对照。结果 CK7在各型BE及正常贲门黏膜中均有较高的表达率,分别为肠化型BE 100%、胃底型BE 86.36%、贲门型BE 95.00%及正常贲门黏膜100%,4组之间差异无统计学意义;而与正常食管黏膜及食管炎组相比差异均有统计学意义(P<0.01);CK20在肠化型、胃底型及贲门型BE中的表达率分别为100%、81.81%及50.00%,差异均有统计学意义(P<0.01);CDX2在肠化型、胃底型及贲门型BE中的表达率分别为100%、59.09%及15.00%,3组BE组织中的CDX2的表达均有统计学意义(P<0.05);CDX2与CK20在各组BE中的表达有明显相关性,两者的表达强度均为肠化型BE>胃底型BE>贲门型BE(rs=0.819,P<0.01)。结论 CK7在各型BE中表达均有较高的敏感性,但缺乏特异性,而CDX2及CK20均可作为肠化型BE的敏感指标。胃底型和贲门型BE虽未在病理组织中见到杯状细胞,但具备了一定的肠化特征。

Objective To analyze the expression of CDX2,CK7 and CK20 in differential pathologic epithelial type of Barrett＇s esophagus（BE）,and to investigate clinical significance of CDX2,CK7and CK20.Methods Immunohistochemistry was used to detect the expression of CDX2,CK7 and CK20 in 60 biopsies of BE（intestinal-metaplasia-type BE,n=18;gastric-type BE,n=22;cardiac-type BE,n=20）.25 biopsies of reflux esophagitis（RE）,10 biopsies of normal esophageal and 10 biopsies of normal cardia was as controls.Results The positive rate of CK7 in intestinal-metaplasia-type BE,gastric fundus-type BE,cardiac-type BE and normal cardia expression were respectively 100%,86.36%,95% and 100%,reflux esophagitis and normal esophageal expression were 16% and 46.67%.There were no statistical differences in each group of columnar epithelium,but there were statistical difference between the columnar epithelium and the squamous epithelium.The positive rate of CK20 in intestinal-metaplasia-type BE,gastric fundus-type BE and cardiac-type BE expression were respectively 100%,81.81% and 50%.The positive rate of CDX2 in intestinal-metaplasia-type BE,gastric fundus-type BE,cardiac-type BE and normal cardia expression were respectively 100%,59.09% and 15%.The expression of intestinal-metaphase-type BE were higher than those of other groups（P0.05）.There was no expression of CK20 and CDX2 in normal esophageal and normal cardia.The positive rate of CK20 and CDX2 in every group had positive correlation.Conclusions The positive rate of CK7 in each group of columnar epithelium are higher than the squamous epithelium.As the specific marker of intestinal metaplasia,positive expression of CK20 and CDX2 is observed in each group of BE,but it is not in normal gastric or esophageal mucosa.The study has indicated that gastric fundus-type BE and cardiac-type BE has no goblet cells,but has the feature of intestinal metaplasia.