血吸虫病性大肠息肉进展为结直肠癌风险评估

Risk Assessment of Intestinal Schistosomiasis Polyp Progress to Colorectal Carcinoma

目的:探讨血吸虫病性大肠息肉是否为癌前病变,从而为内镜下息肉切除适应证提供依据。方法:收集70例血吸虫病性大肠息肉及相应患者正常肠黏膜组织,68例结直肠癌组织,采用实时定量PCR检测CK-20、Bcl-2、p27基因的表达,并通过TUNEL法检测相应组织的细胞凋亡。结果:腺瘤性血吸虫病性大肠息肉中,癌基因Bcl-2、CK-20mRNA表达较非腺瘤性血吸虫病性大肠息肉和正常肠黏膜组织均有不同程度上调(P<0.001),抑癌基因p27表达明显下调(P<0.001);腺瘤性血吸虫病性大肠息肉中CK-20、p27表达较结直肠癌组织无明显差异(P>0.05)。TUNEL法检测细胞凋亡结果发现,非腺瘤性血吸虫病性息肉组织凋亡率明显低于结直肠癌组织,差异有显著性(P=0.032);腺瘤性大肠息肉凋亡率低于大肠癌组织,但无统计学差异(P=0.315)。结论:腺瘤性血吸虫病性大肠息肉为癌前病变,非腺瘤性息肉为炎性增生性病变,在行内镜下息肉切除时应注意甄别,避免过度治疗。

To investigate whether intestinal polyp is a precancerous lesion, so as to provide evidences for schistosomiasi carcinoma wer PCR, and apo tissue, CK-20 endoscopic schistosomiasis polypectomy. Methods： Seventy samples of intestinal s polyp, 70 matching normal intestinal tissue samples, and 68 samples of colorectal e collected. CK-20, Bcl-2, and p27 mRNA expression were detected by real time ptosis of the tissue cells was tested by TUNEL. Results： In adenomatous polypus and Bcl-2 expression were up-regulated （P〈0. 001）, while p27 expression was down-regulated as compared with that in non adenomatous polypus and normal intestinal tissue （P〈0. 001）. There was no difference between adenomatous polypus and colorectal carcinoma in the CK-20, Bcl 2 and p27 mRNA detection. In the TUNEL detection of apoptosis, apoptosis rate of non-adenomatous polypus was less than that of colorectal carcinoma （P=0. 032）. Conclusion： Adenomatous polyp is a precancerous lesion, but non-adenomatous polyp is not. It is recommen- ded for intestinal schistomiasis polyp to receive endoscopic polypectomy.