人直肠异常隐窝病灶的2年随访研究

Two-year follow-up study of human rectum aberrant crypt foci

目的:异常隐窝病灶(aberrant crypt foci,ACF)目前被广泛认为是光镜下可视最早期的大肠癌癌前病变。本研究在2年时间通过结肠镜下动态观察ACF的变化来初步探讨ACF与结直肠癌的关系。方法:选取2013年1月至2014年12月在山西医科大学第二医院接受结肠镜检查并排除常见致癌及抑癌因素的100例患者,常规在退镜时进行直肠靛胭脂染色,观察并记录初次结肠镜检查、1年及2年复查肠镜时直肠ACF的数目及单个ACF的自然发展变化过程。结果:初次检查及1年和2年后的ACF阳性率比较,差异无统计学意义。ACF随时间的变化大部分继续存在或自行消失,少数发展为息肉、腺瘤,ACF<6枚的病例,以及腺管开口为椭圆形的ACF自行消失率更大,而腺管开口为非椭圆形者更易发展为息肉或腺瘤。结论:ACF变化呈异质性,其中部分可能为大肠癌癌前病变。

Objective： To investigate the relationship between aberrant crypt foci（ACF） and colorectal cancer through a 2-year followup colonoscopy observation of patients with ACF. Methods： We enrolled 100 patients who accepted colonoscopies from January 2013 to December 2014 in The Second Hospital of Shanxi Medical University. The patients did not have common carcinogenic or cancer-suppressing factors and agreed to participate in the study. Routine rectal indigo carmine staining was carried out, and we observed and recorded the number of ACFs and the natural development process of single ACFs at the baseline, the 1 st year, the 2 nd year using colonoscopies. Results： There was no statistical difference in ACF positive incidence among baseline, 1 st year, and 2 nd year exams. During the 2-year observation, most ACFs remained or disappeared, and only a few developed into polyps or adenomas, which were common in subjects with ≥6 ACFs; while those with oval crypt openings mostly died away. Conclusions： ACFs are heterogeneous, and only a subset of ACFs may be biomarkers for colorectal cancer.