不同级别胃黏膜癌前病变的临床病理诊断

Clinical Pathological Diagnosis of Gastric Mucosal Precancerous Lesions at Different Levels

目的探讨胃黏膜腺体上皮低级别异型增生(GELD)、高级别异型增生(GEHD)的临床病理特征以及P53、Ki-67辅助判定上述两种病变的临床应用价值。方法选择我院2010年1月—2011年12月收治的胃黏膜活检组织中伴腺体上皮异型增生的63例,据Padova及WHO分类标准分为GELD组(42例)和GEHD组(21例),观察两组病变的组织形态学特点,分析P53、Ki-67在两组病变中的表达情况。结果 GEHD组较GELD组组织结构更加紊乱,细胞异型性更加明显。两组P53阳性表达率分别为21.43%、61.90%(χ2=10.09,P<0.05);Ki-67表达阳性率及分布部位百分比差异有统计学意义(χ2=12.19,P<0.05;χ2=32.14,P<0.05)。结论胃黏膜癌前病变的诊断除观察病变组织形态学特点外,还可检测P53及Ki-67的免疫组化染色表达,对规范临床治疗及指导预后有重要意义。

Objective To explore the clinicopathologic features of gastric epithelial low grade dysplasia （GELD） and gastric epithelial high grade dysplasia （GEHD） , and clinical value of P53 and proliferating cell nuclear antigen （Ki-67） ex- pressions in secondary judgment of the two lesions. Methods A total of 63 patients with gland epithelial dysplasia in gastric mucosa biopsy tissues during January 2010 and December 2011 were divided into GELD group （n = 42） and GEHD group （n = 21 ） according to Padova and the WHO separate criteria. Histomorphology characteristics of lesions in the two groups were observed, and expressions of P53 and Ki-67 in the two groups were analyzed. Results The organization structure and cell dysplasia were in worse disorder in GEHD group compared with those in GELD group. The P53 positive expression rate was 21.43% in GEHD group and 61.90% in GELD group respectively, and the difference was statistically significant （X2 = 10.09, P 〈 0.05 ） ; the differences of Ki-67 positive expression rate and percentage of distribution part were statistically signif- icant （X2 =12.19, P〈0.05;X2 =32. 14, P 〈0.05）. Conclusion The diagnosis of gastric mucosal precancerous lesions can be made by observing histomorphology characteristics, and immunohistostaining expressions of P53 and Ki-67 are also reli- able indicators, which may help standardize the clinical treatment and improve prognosis.