胆汁反流性胃炎与肠化生的关系及其分子机制

Relationship between bile reflux gastritis and intestinal metaplasia and related molecular mechanism

目的探讨胆汁反流性胃炎与肠化生之间的关系以及相关的分子机制。方法收集2019年10月至2020年10月在空军军医大学第二附属医院消化科内镜中心诊断为胆汁反流性胃炎的350例患者作为病例组,包括轻度胆汁反流组215例(胆汁反流Ⅰ度113例、胆汁反流Ⅱ度102例)和重度胆汁反流(胆汁反流Ⅲ度)组135例。对活检标本行HE染色及AB-PAS染色明确有无肠化生及病理分型,对确诊肠化生的标本采用免疫组化染色法测定CDX2、SOX2、TGR5的表达情况。结果重度胆汁反流组肠化生发生率显著高于轻度胆汁反流组(χ^(2)=6.893,P<0.05);重度胆汁反流组不完全型肠化生的发生率显著高于轻度胆汁反流组(χ^(2)=12.969,P<0.05);重度胆汁反流组CDX2的高表达率显著高于轻度胆汁反流组(χ^(2)=6.918,P<0.05);重度胆汁反流组TGR5的高表达率显著高于轻度胆汁反流组(χ^(2)=4.967,P<0.05);重度胆汁反流组SOX2的高表达率显著低于轻度胆汁反流组(χ^(2)=7.839,P<0.05)。结论胆汁反流程度会影响肠化生发生率及肠化生的病理类型;而且胆汁反流可能会通过影响CDX2、SOX2和TGR5的表达来参与肠化过程。

Objective To investigate the relationship between bile reflux gastritis and intestinal metaplasia,and explore the related molecular mechanism.Methods A total of 350 patients diagnosed with bile reflux gastritis in the Gastroenterology Endoscopy Center of the Second Affiliated Hospital of Air Force Medical University from October 2019 to October 2020 were collected,including 215 cases of mild bile reflux(113 cases of bile reflux degreeⅠand 102 cases of bile reflux degreeⅡ)and 135 cases of severe bile reflux(bile reflux degreeⅢ).HE staining and AB-PAS staining were performed on biopsy specimens to evaluate intestinal metaplasia and pathological typing.Immunohistochemical staining was used to determine the expression levels of CDX2,SOX2 and TGR5 in the specimens with confirmed intestinal metaplasia.Results The rate of intestinal metaplasia in patients with severe bile reflux was significantly higher than that in patients with mild bile reflux(χ^(2)=6.893,P<0.05).The rate of incomplete intestinal metaplasia in patients with severe bile reflux was significantly higher than that in patients with mild bile reflux(χ^(2)=12.969,P<0.05).The rate of high expression of CDX2 in patients with severe bile reflux was significantly higher than that in patients with mild bile reflux(χ^(2)=6.918,P<0.05).The rate of high expression of TGR5 in patients with severe bile reflux was significantly higher than that in patients with mild bile reflux(χ^(2)=4.967,P<0.05).The rate of high expression of SOX2 in patients with severe bile reflux was significantly lower than that in patients with mild bile reflux(χ^(2)=7.839,P<0.05).Conclusion The degree of bile reflux has influences on the incidence of intestinal metaplasia and the pathological type of intestinal metaplasia.Moreover,bile reflux may be involved in intestinal metaplasia by affecting the expression of CDX2,SOX2 and TGR5.