增殖细胞核抗原和p53在反流性食管炎黏膜的表达及其意义

The expression and implication of proliferating cell nuclear antigen and p53 protein in reflux esophagitis lesions

目的 探讨增殖细胞核抗原 (PCNA)和p5 3在反流性食管炎 (RE)及治疗干预后内镜下恢复正常的食管上皮的表达及其意义。方法 2 13例RE及 2 6例治疗后内镜下恢复正常的食管上皮活检标本 ,组织病理学HE染色 ,并采用卵白素 生物素 过氧化物酶复合物法测定PCNA和p5 3的表达。结果 随着食管黏膜从正常到RE和非典型增生 ,PCNA阳性细胞数分别为 (192± 12 0 ) /mm2 、(32 6± 2 0 0 ) /mm2 、(5 96± 2 0 8) /mm2 ,各组之间差异有显著性 (P <0 0 1) ;p5 3阳性表达率逐渐升高 ,分别为5 9%、34 4 %、5 7 6 %,各组之间差异有显著性 (P <0 0 1)。 2 6例RE病人经干预治疗后内镜下食管黏膜形态恢复正常 ,其食管黏膜的PCNA阳性细胞数为 (30 6± 2 14) /mm2 ,p5 3阳性率为 2 6 9%,均较干预前的 (4 83± 2 18) /mm2 和 6 1 5 %明显降低 (P <0 0 1) ;但仍然高于正常对照组 (P <0 0 1)。结论 随食管反流性病变的加重 ,PCNA及p5 3蛋白的表达增加 ;RE患者经干预治疗后内镜下恢复正常者 ,其食管黏膜在分子水平尚未达到正常 ,故仍需维持治疗和内镜随访。

Objective To characterize expression of proliferating cell nuclear antigen (PCNA) and p53 protein in esophageal mucosa of reflux esophagitis(RE) and which returning to normal endoscopically after intervening therapy.Methods Esophageal biopsies were taken from 213 case of RE and 26 case returning to normal endoscopically after intervening therapy, which were examined by pathology and avidin-biotin-peroxidase complex(ABC) method. Results The number of PCNA-positive cells in esophageal mucosa increased from normal to RE and to dysplasia, with the values being (192±120)/mm 2,(326±200)/mm 2,(596±208)/mm 2 respectively. There was statistically significant difference between intergroups (P<0.01). The positive rates of p53 protein in esophageal mucosa increased from normal to RE and to dysplasia and they were 5.9%,34.4%,57.6%. Marked difference was found between intergroups (P<0.01). The number of PCNA-positive cells in esophageal mucosa of RE patients which appear to be normal under endoscope after intervening therapy [(306±214)/mm 2 ] and the positive rates of p53 protein (26.9%) were significantly lower than those in RE patients before intervening therapy (P<0.01), but were significantly higher than those in normal controls (P<0.01).Conclusions The expression of PCNA and p53 protein increased with the severity of esophageal reflux lesions. The case of reflux esophagitis who returned to normal endoscopically after intervening therapy need keeping on therapy and being followed by endoscopy, because their esophageal mucosa didn′t become normal at the molecular level.