Barrett食管的形态学、免疫组织化学及hTERC基因表达

Morphology, immunohistochemistry and hTERC gene in-situ hybridization in Barrett＇s esophagus

目的探讨Barrett食管（BE）活检标本的临床病理学特点及与近端胃肠化黏膜的鉴别诊断。方法按WHO标准选取BE标本38例，观察病理组织学特征，对38例BE、44例近端胃肠化黏膜进行免疫组织化学CK7、CK20、CK4、CK8、SLOOP、MUC6、COX2、bc1-2观察，并用荧光原位杂交（FISH）方法检测hTERC基因情况。结果BE和近端胃肠化黏膜中CK7、CK20、MUC6、COX2、bc1-2表达差异无统计学意义（P〉0．05）。SLOOP阳性表达在BE与近端胃肠化黏膜间差异有统计学意义（P〈0．05）；BE中CK7与CK4、CK7与CK8表达结果呈正相关（P〈0．05）。近端胃肠化黏膜中CK7与CK4、CK7与CK8表达结果均无相关性（P〉0．05）；使用FISH方法检测两组标本hTERC基因的表达情况，BE组阳性率为57．9％（22／38），而近端胃肠化黏膜阳性率为13．6％（6／44），两者差异有统计学意义（P〈0．05）。结论在鉴别BE和近端胃肠化黏膜中CK7与CK20表达的意义尚不能肯定；而CK7／CK4／CK8同时阳性可能支持BE的诊断，对鉴别两者有一定作用。SLOOP有可能作为鉴别BE和近端胃肠化黏膜两者的免疫标志物；hTERC基因扩增检测可能有助于BE诊断，并提示BE向食管腺癌发展的过程中该基因可能起重要作用。

Objective To study the clinicopathologic features and differential diagnosis of proximal gastric mucosa and mucosa of Barrett＇s esophagus （BE） in biopsy specimens. Method Thirty-eight cases of Barrett＇s esophagus （ diagnosed using WHO criteria） and 44 cases of proximal gastric mucosa were studied by immunohistoehemistry （for CKT, CK20, CK4, CKS, S-100 protein, MUC6, COX2 and bcl-2） and fluorescence in-situ hybridization （FISH） （for hTERC gene ）. The pathologic features were analyzed. Results The differences in expression of CK7, CK20, MUC6, COX2 and bcl-2 between BE and proximal gastric mucosa with intestinal metaplasia were not statistically significant （ P 〉 0.05 ）. There was however a statistically significant difference in expression of S-100 protein （ P 〈 0. 05 ）. The expression of CKT/CK4 and CKT/CK8 in BE showed positive correlation （P 〈 0. 05 ）. However, such correlation was not demonstrated in proximal gastric mucosa（ P 〉 0. 05 ）. The results of hTERC gene expression by FISH showed a statistically significant difference between the two groups： 57.9% （22/38） in BE and 13.6% （6/44） in proximal gastric mucosa （ P 〈 0. 05 ）. Conclusions The significance of CK7 and CK20 expression is uncertain in the differential diagnosis between BE and proximal gastric mucosa. On the other hand, positivity for CK7/CK4/CK8 may support the diagnosis of BE and play a role in distinguishing between the two groups. S-100 protein expression and detection of hTERC gene amplification also contribute to the diagnosis of BE.