245例早期胃癌胃微血管形态变化及Bcl-2和P53表达特点的研究

The Morphologic Change of Gastric Microvessels and the Expression of Bcl-2 and p53 in the Early Gastric Cancer of 245 Patients

目的:研究早期胃癌微血管形态变化以及Bcl-2和P53在早期胃癌中的表达特点。方法:选取245例消化不良症状的住院患者,首先用放大内镜观察胃微血管形态,然后根据胃小凹状况分为A、B、C、D、E型,分别检测不同胃小凹分型标本中Bcl-2和P53阳性率。结果:浅表性胃炎主要见于A型(57.9%)、B型(49.0%)和c型(20.0%)小凹类型;萎缩性主要见于C型(40.0%)和D型(50.0%);肠上皮化生主要见于C型(32.0%)、D型(35.7%)和E型36.0%);不典型增生多见于D型(10.7%)和E型(34.0%);胃癌仅见于E型(14.0%)。不同类型的微血管形态,其Bcl-2和P53阳性率比较,差异有统计学意义。E型小凹的标本中Bcl-2和P53阳性率分别为68.0%与62.0%,均显著高于A(5.2%与7.8%)、B(7.8%与11.8%)、C(18.0%与16.0%)、D型(26.8%与30.4%),差异有统计学意义;D型小凹的标本中Bcl-2和P53阳性率均显著高于B型,差异亦有统计学意义。结论:早期胃癌及癌前病变主要发生在D、E型小凹类型;微血管形态可作为早期胃癌的诊断指标,放大内镜可以作为早期胃癌诊断的一种临床筛选方法。

Objective： To explore the morphological changes of gastric microvessels and the expression of Bcl-2 and p53 in the early gastric cancer.Methods： 245 patients with upper abdominal discomfort,abdominal pain,bloating,acid reflux indigestion and other symptoms of digestion accepted by digestive surgery in our hospital were examined with magnifying endoscopy to observe the gastric microvessels.The patients were divided into five types according to different status of gastric pit.The positive rate of Bcl-2 and p53 of different types were detected respectively.Results： Superficial gastritis mainly showed in A-type-C type;atrophic gastritis,mainly in the C-and D-type;Intestinal metaplasia mainly in the C-type D-type and E-type;atypical hyperplasia prevalent in the D and E-type;gastric cancer only in E-type.The difference of the positive rate of Bcl-2 and p53 detected in different types of gastric pit group were significant（P0.01）.The positive rate of Bcl-2 and p53 in E-type gastric pit（68.0% and 62.0%）,was significantly higher than that in A-type（5.2% and 7.8%）,B-type（7.8% and 11.8%）,C-type（18.0% and 16.0%） and D-type（26.8% and 30.4%）（P 0.01）.The positive rate of Bcl-2 and p53 in D-type gastric pit was higher than that of in B-type.And the difference was significant（P 0.05）.Conclusions： Precancerous lesions and early gastric cancer mainly occur in type D and type E gastrie pit,Microvascnlar patterns can be a diadynamic criteria for the early gastric cancer,and magnifying endoscopy can be used as a screening method of early gastric cancer diagnosis.