Helicobacter pylori,esophageal precancerous lesions,and proton pump inhibitor overuse

This article reviews the cohort study published in the World Journal of Gastroenterology,which reported low rates of Helicobacter pylori(H.pylori)infection among esophageal cancer(EC)patients,coupled with proton pump inhibitor(PPI)overuse.These findings suggest a potential protective role of H.pylori against EC and indicate a possible association between PPI use and increased cancer risk.In light of these findings,our article examines the complex relationship between H.pylori and esophageal precancerous lesions,exploring the potential underlying mechanisms.We also address growing concerns regarding PPI overuse,including its potential effects on cancer therapy efficacy and the risk of drug interactions.Ultimately,this article highlights the urgent need for further research to evaluate the safety and efficacy of PPIs in cancer patients and to better understand their broader implications.

Value of serum pepsinogen ratio screening for early gastric cancer and precancerous lesions in Youcheng area

BACKGROUND The 5-year survival rate of patients with advanced gastric cancer remains extremely low(<15%),whereas the 5-year survival rate of patients with early gastric cancer(EGC)is>90%.Consequently,strengthening the screening of patients with EGC and precancerous lesions(PCLs)is essential.AIM To identify the value of serum pepsinogen ratio(PGR)screening for EGC and PCLs in the Shengli Oilfield Central Hospital.METHODS We first selected 385 patients with gastric lesions in the Youcheng area,deter-mining benign lesions,PCLs,and EGC in 135,123,and 127 cases,respec-tively,based on endoscopy and case diagnosis.The positive rates of pepsinogen I,pep-sinogen II and Helicobacter pylori(H.pylori)in the three groups were detected,and the PGR was calculated.Subsequently,we plotted receiver operating charac-teristic curves to analyze the screening value of PGR and H.pylori-positive rates for PCLs and EGC.RESULTS PGR expression demonstrated a decreasing trend in patients with benign lesions,PCLs,and EGC successively according to the detection results,whereas the H.pylori-positive rate was notably increased in patients with PCLs and EGC compared to those with benign lesions.The area under the curves(AUCs)of PGR,H.pylori,and their combination in differentiating patients with benign lesions from those with PCLs were 0.611,0.582,and 0.689,respectively;PGR,H.pylori,and their combination had an AUC of 0.618,0.502,and 0.618 in distinguishing PCL patients from EGC patients,respectively;the AUCs of PGR,H.pylori,and their combination in discriminating patients with benign lesions from those with EGC were 0.708,0.581,and 0.750,respectively.CONCLUSION PGR has great screening potential for patients with EGC and PCLs in the Youcheng area,and the screening efficiency is further improved by combining the H.pylori-positive rate.

Comparison between peroral traction-assisted ESD and traditional ESD treatment for early gastric cancer and precancerous lesions

Objective:To explore the differences in the effect of peroral traction-assisted endoscopic submucosal dissection (ESD) and traditional ESD for the treatment of early gastric cancer and precancerous lesions. Methods:112 patients with early gastric cancer and precancerous lesions treated in our hospital between May 2013 and May 2016 were collected and divided into control group and observation group according to the random number table (n=56). Observation group of patients received peroral traction-assisted ESD, and the control group of patients only received traditional ESD. The intraoperative dissected lesion diameter, mean operation time and intraoperative blood loss of two groups of patients were recorded, enzyme-linked immunosorbent assay was used to detect serum inflammatory factor levels, and RIA was used to detect serum stress hormone levels. Results:Dissected lesion diameter of observation group was greater than that of control group (P<0.05) while mean operation time and intraoperative blood loss were less than those of control group (P<0.05);1 d after operation, serum inflammatory factors interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-12 (IL-12) and tumor necrosis factor-α(TNF-α) levels of observation group were lower than those of control group (P<0.05), and serum stress hormones cortisol (Cor),β-endorphin (β-EP), epinephrine (E), norepinephrine (NE) and angiotensin II (ATII) levels were lower than those of control group (P<0.05). Conclusions:Peroral traction-assisted ESD can effectively increase the lesion dissection effect and reduce the postoperative inflammatory response and stress response in patients with early gastric cancer and precancerous lesions.

Linked color imaging vs Lugol chromoendoscopy for esophageal squamous cell cancer and precancerous lesion screening: A noninferiority study

BACKGROUND Lugol chromoendoscopy(LCE)has served as a standard screening technique in high-risk patients with esophageal cancer.Nevertheless,LCE is not suitable for general population screening given its side effects.Linked color imaging(LCI)is a novel image-enhanced endoscopic technique that can distinguish subtle differences in mucosal color.AIM To compare the diagnostic performance of LCI with LCE in detecting esophageal squamous cell cancer and precancerous lesions and to evaluate whether LCE can be replaced by LCI in detecting esophageal neoplastic lesions.METHODS In this prospective study,we enrolled 543 patients who underwent white light imaging(WLI),LCI and LCE successively.We compared the sensitivity and specificity of LCI and LCE in the detection of esophageal neoplastic lesions.Clinicopathological features and color analysis of lesions were assessed.RESULTS In total,43 patients(45 neoplastic lesions)were analyzed.Among them,36 patients(38 neoplastic lesions)were diagnosed with LCI,and 39 patients(41 neoplastic lesions)were diagnosed with LCE.The sensitivity of LCI was similar to that of LCE(83.7%vs 90.7%,P=0.520),whereas the specificity of LCI was greater than that of LCE(92.4%vs 87.0%,P=0.007).The LCI procedure time in the esophageal examination was significantly shorter than that of LCE[42(34,50)s vs 160(130,189)s,P<0.001].The color difference between the lesion and surrounding mucosa in LCI was significantly greater than that observed with WLI.However,the color difference in LCI was similar in different pathological types of esophageal squamous cell cancer.CONCLUSION LCI offers greater specificity than LCE in the detection of esophageal squamous cell cancer and precancerous lesions,and LCI represents a promising screening strategy for general populations.

Population-based study of DNA image cytometry as screening method for esophageal cancer

AIM:To explore the DNA image cytometry (DNA-ICM) technique as a primary screening method for esopha-geal squamous precancerous lesions.METHODS:This study was designed as a population-based screening study.A total of 582 local residents aged 40 years-69 years were recruited from Linzhou in Henan and Feicheng in Shandong.However,only 452 subjects had results of liquid-based cytology,DNA-ICM and pathology.The sensitivity and specificity of DNA-ICM were calculated and compared with liquid-based cytology in moderate dysplasia or worse.RESULTS:Sensitivities of DNA-ICM ranging from at least 1 to 4 aneuploid cells were 90.91%,86.36%,79.55% and 77.27%,respectively,which were better than that of liquid-based cytology (75%).Specifici-ties of DNA-ICM were 70.83%,84.07%,92.65% and 96.81%,but the specificity of liquid-based cytology was 91.91%.The sensitivity and specificity of a combination of liquid-based cytology and DNA-ICM were 84.09% and 85.78%,respectively.CONCLUSION:It is possible to use DNA-ICM tech-nique as a primary screening method for esophageal squamous precancerous lesions.

Magnifying chromoendoscopy combined with immunohistochemical staining for early diagnosis of gastric cancer

AIM:To assess the diagnostic value of using magnifying chromoendoscopy combined with immunohisto-chemical staining of proliferating cell nuclear antigen (PCNA)and p53 in the detection of gastric precancerous lesions. METHODS:Ninety-five patients who were treated for abdominal discomfort,abdominal pain,bloating,and acid reflux at our hospital from January 2010 to December 2011 were included in the study.An ordinary gastroscopic procedure was initially performed to select the lesions.All subjects underwent magnifying chromo-endoscopy to observe morphological changes of gastric pits.Biopsies were then taken from each area of interest and sent for pathological examination and detection of PCNA and p53 expression by immunohistochemistry. An immunoreactivity score for each lesion was calcu-lated.Based on immunoreactivity scores,immunohisto-chemical staining was then considered. RESULTS:Compared to intestinal metaplasia,gastric pits were more diverse in size,more irregular in shape, and more disorderly in arrangement in moderate and severe dysplasia.PCNA and p53 expression was sig-nificantly higher in precancerous lesions(intestinal metaplasia and dysplasia)than in chronic gastritis. PCNA expression showed an upward trend in types A-F pits.The number of cases that showed strong PCNA positivity increased significantly with an increase in the severity of lesions.Rank sum test for independent samples showed that p53 expression was significantly higher in types E and F pits than in types A-D pits(H =33.068,P=0.000).Rank sum test for independent samples showed that PCNA expression was significantly higher in types E and F pits than in types A-D pits(H =31.791,P=0.001). CONCLUSION:The presence of types E and F pits,in which p53 and PCNA are highly expressed,is highly sug- gestive of the occurrence of early cancer,and patients developing these changes should be closely followed.

NATURAL HISTORY OBSERVATION FOR ESOPHAGEAL AND CARDIA PRECURSORS BY REPETITIVE ENDOSCOPIC SCREENING OF 301 SUBJECTS IN SHEXIAN

OBJECTIVE To investigate the natural history of fast developing esophageal and cardia precursors.METHODS Repetitive endoscopic screenings were performed among 40-69-year-olds in the high-incidence areas for esophageal cancer in Shexian. RESULTS The initial diagnosis and the lag-time for 7 subsequently identified severe dysplasia （SD） subjects were as follows： in one subject 13 months after a baseline diagnosis of normal epithelium, in another subject 7 months after a baseline diagnosis of base cell hyperplasia （BCH）, in four subjects 3, 4, 4, and 10.5 months after baseline diagnosis of mild dysplasia （mD）, and in one subject 12.5 months after a baseline diagnosis of moderate dysplasia （MD）. The initial diagnosis and the lag-time for 6 subsequently identified carcinomas in situ or intramucosal carcinoma cases were： in one case 48 months after a baseline diagnosis of mD, in 2 cases 4 and 13 months after baseline diagnoses of MD, and in the other 3 cases 3.5, 9, and 17.5 months after baseline diagnoses of SD. The initial diagnosis and lag-time for 3 subsequently identified invasive cancer cases, were： in one case 50 months after a baseline diagnosis of MD, in 2 cases 14 and 19 months after baseline diagnoses of SD. In addition, during a 4-year-follow-up of 18 subjects after endoscopic mucosa resection, 9 of them were found to have developed precursors again at other sites, and also additional findings were obtained for 11 of the 16 dysplasia cases by repetitive biopsy in less than 2 months after the initial endoscopy. CONCLUSION A 5-year screening interval for BCH and mD, and a 3-year interval for MD may be too long for the fast developing precursors. Periodic screenings with shorter intervals should be considered to control the number of interval cases due to fast development, multifocal carcinogenesis, and false negative results inherent in one-time endoscopic biopsy sampling.

Loss of heterozygosity in multistage carcinogenesis of esophageal carcinoma at high-incidence area in Henan Province, China

AIM: Microsatellites are the repeated DNA sequences scattered widely within the genomes and closely linked with many important genes. This study was designed to characterize the changes of microsatellite DNA loss of heterozygosity (LOH) in esophageal carcinogenesis. METHODS: Allelic deletions in 32 cases of matched precancerous, cancerous and normal tissues were examined by syringe microdissection under an anatomic microscope and microsatellite polymorphism analysis using 15 polymorphic markers on chromosomes 3p, 5q, 6p, 9p, 13q,17p, 17q and 18q.RESULTS: Microsatellite DNA LOH was observed in precancerous and cancerous tissues, except D9S1752. The rate of LOH increased remarkably with the lesions progressed from basal cell hyperplasia (BCH) to squamous cell carcinoma (SCC) (P＜0.05). Three markers, D9S171, D13S260 and TP53, showed the highest incidence of LOH (＞60%). LOH loci were different in precancerous and cancerous tissues. LOH in D3S1234 and TP53 was the common event in different lesions from the same patients. CONCLUSION: Microsatellite DNA LOH occurs in early stage of human esophageal carcinogenesis, even in BCH. With the lesion progressed, gene instability increases, the accumulation of this change may be one of the important mechanisms driving precancerous lesions to cancer.

Recent advances in the mechanisms of development and the early diagnosis and treatment of esophageal cancer

The occurrence and development of esophageal cancer(EC)is a multi-stage process involving from inflammation to invasive cancer.However,this process is very complex,and so far there are few relevant studies to reveal this process.Early diagnosis and treatment of EC is the focus of the early diagnosis and treatment of malignant tumors project in China.How to screen EC in a lower cost and more efficient way deserves to be explored.Here,we reviewed the recent advances in the mechanisms of the occurrence and development,and early diagnosis and treatment of EC.

江苏省农村地区居民食管癌及癌前病变影响因素分析

目的了解江苏省农村地区居民食管癌及癌前病变检出情况及影响因素,为食管癌的预防提供理论依据。方法2017年1月至2022年12月“江苏省农村上消化道癌早诊早治”项目采用整群抽样的方法抽取40~69岁常住居民参与研究,选取其中51198名40~69岁居民作为调查对象,进行危险因素问卷调查、内镜检查和组织活检,根据病理诊断确定食管癌癌前病变或食管癌。采用SPSS 22.0软件进行χ^(2)检验。采用无序多分类Logistic回归分析食管癌前病变和食管癌的影响因素。结果51198名调查对象检出食管癌前病变1279例,检出率2.50%,食管癌741例,检出率1.45%。无序多分类Logistic回归分析结果显示,高中及以上教育水平(OR=0.81,95%CI:0.66~0.98)、家庭收入≥5万(OR=0.82,95%CI:0.73~0.93)和每周食用1~2次新鲜水果(OR=0.70,95%CI:0.52~0.93)是食管癌前病变低风险相关的因素;男性(OR=1.45,95%CI:1.27~1.65)、年龄(OR=5.35,95%CI:4.22~6.79)、食用腌晒食物(<2次/周:OR=1.80,95%CI:1.42~2.28;≥2次/周:OR=3.01,95%CI:2.35~3.87)、食管炎(OR=1.65,95%CI:1.19~2.31)和吃饭生气(OR=2.43,95%CI:2.07~2.85)是食管癌前病变高风险相关的因素。家庭收入≥5万(OR=0.74,95%CI:0.64~0.86)是食管癌低风险相关的因素;男性(OR=1.64,95%CI:1.38~1.95)、年龄(OR=5.54,95%CI:4.11~7.46)、每周食用1~2次霉变食物(OR=1.87,95%CI:1.38~2.54)、食管炎(OR=1.86,95%CI:1.22~2.86)和吃饭生气(OR=2.95,95%CI:2.37~3.67)是食管癌高风险相关的因素。结论江苏省农村地区居民食管癌及癌前病变检出率较高,应加强男性、高龄、有食管炎史和饮食习惯不良人群的食管癌健康知识宣传,以降低食管癌患病风险。

内镜治疗肝硬化患者上消化道早癌的风险及处理策略

肝硬化患者患上消化道肿瘤风险增加,尤其是酒精性肝硬化患者.随着内镜检查的推广及普及,越来越多的上消化道早癌得以早期发现及治疗.内镜治疗已成为上消化道早癌的首选治疗方式,肝硬化患者由于可能存在血小板减少、凝血功能障碍、合并食管胃静脉曲张等情况,内镜治疗过程中出血、感染等风险较大.近年来国内外已有部分研究探讨内镜治疗肝硬化伴上消化道早癌的安全性及有效性.本文总结了近年来发表的内镜治疗肝硬化伴上消化道早癌的研究结果,简要综述其风险及防治策略,为临床提供指导.

ADCY7、GPR86、GRIN2D、RGS4对胃癌前病变进展的预测价值

背景:目前临床上尚无有效预测胃癌前病变进展或筛查早期胃癌的生物学标志物。目的:研究腺苷酸环化酶7(ADCY7)、G蛋白偶联受体GPR86、N⁃甲基⁃D⁃天冬氨酸离子能谷氨酸受体2D(GRIN2D)、G蛋白信号调节因子4(RGS4)在不同胃黏膜病变中的表达及其对胃癌前病变进展的预测价值。方法:应用免疫组化法、real-time PCR和蛋白质印迹法检测ADCY7、GPR86、GRIN2D、RGS4在Correa级联各阶段(包括慢性非萎缩性胃炎、慢性萎缩性胃炎、低级别和高级别上皮内瘤变、黏膜层和黏膜下层早期胃癌)以及胃癌与相应癌旁组织间的表达差异。结果:ADCY7、GPR86、GRIN2D、RGS4在胃炎、上皮内瘤变、早期胃癌中的表达呈递增趋势,除GRIN2D在上皮内瘤变与早期胃癌中的表达无明显差异外,两两比较差异均有统计学意义(P均<0.001)。GPR86、GRIN2D mRNA和蛋白在胃癌组织中的表达显著高于癌旁>5 cm组织(P均<0.05);RGS4蛋白在胃癌组织中的表达高于癌旁>5 cm组织,其mRNA表达趋势则相反(P均<0.05);ADCY7仅蛋白表达在胃癌与癌旁>5 cm组织间差异显著(P<0.05)。结论:ADCY7、GPR86、GRIN2D、RGS4在Correa级联各阶段以及胃癌与相应癌旁组织间的表达变化提示其参与了胃癌前病变的发生、发展,可能具有预测胃癌前病变进展的价值。

不同病变长径的早期食管癌患者经内镜下黏膜剥离术治疗的疗效及并发症比较

目的探讨不同病变长径的早期食管癌患者经内镜下黏膜剥离术治疗的疗效及并发症比较。方法收集采用经内镜下黏膜剥离术治疗的早期食管癌病变长径<3 cm的早期食管癌患者65例为对照组,收集同期病变直径>3 cm经内镜下黏膜剥离术的早期食管癌患者85例为试验组。对比两组患者的病灶切除效果,围术期情况,治疗前后3个月的血清肿瘤标志物水平及两组患者的并发症发生率。结果两组患者的整块切除率和完全切除率对比无差异(P>0.05);试验组患者的手术时间、术后禁食时间长于对照组(P<0.05),抗生素使用时间、住院时间对比无差异(P>0.05);治疗3个月后,两组患者的CEA、SCC-Ag、CA19-9的水平均较治疗前低(P<0.05),但两组患者的CEA、SCC-Ag、CA19-9水平对比无差异(P>0.05);试验组患者的并发症发生率较对照组高(P<0.05)。结论经内镜下黏膜剥离术治疗不同病变长径的早期食管癌患者的切除效果、3个月后的肿瘤标志物水平、抗生素使用时间和住院时间相近,病变长径较长者的手术时间、术后进食时间以及并发生发生率略高于病变长径较短者,具有临床参考意义。

内镜下黏膜剥离术治疗食管早癌的临床研究

目的评价内镜下黏膜剥离术治疗食管早癌的疗效和安全性。方法选取2021年1月—2022年12月我院收治的60例食管早癌患者为研究对象,按照手术方式不同分为两组,每组30例,分别实施常规外科手术与内镜下黏膜剥离术。比较两组各项临床指标、病灶剥离与切除情况、术后并发症发生情况及生活质量水平。结果研究组的出院时间、手术时间、术后进食时间短于对照组(P<0.05)。研究组的出血量少于对照组(P<0.05)。研究组的病灶剥离与切除效果优于对照组(P<0.05)。研究组的术后并发症总发生率低于对照组(P<0.05)。研究组的生活质量水平高于对照组(P<0.05)。结论内镜下黏膜剥离术治疗食管早癌,其可以有效优化患者各项临床指标与病灶剥离与切除效果,并大幅度降低并发症的发生率,治疗安全性较高。

内镜下碘染色在早期食管癌及癌前病变诊断中的应用效果

目的:探讨内镜下碘染色在早期食管癌及癌前病变诊断中的应用效果。方法:选取2022年1月—2023年3月南京医科大学附属淮安第一医院收治的疑似早期食管癌或癌前病变患者40例作为研究对象,患者均采用电子上消化道内镜完成食管内镜检查及取样,观察碘染色效果。统计患者术后病理诊断结果,以术后病理诊断结果为“金标准”,统计碘染色诊断早期食管癌及癌前病变的灵敏度、特异度、准确度。结果:术后病理组织学检查确诊早期食管癌患者16例,慢性炎性反应患者5例,低级别上皮内瘤变(lowgradeintraepithelialneoplasia,LGIN)患者14例,高级别上皮内瘤变(highgradeintraepithelialneoplasia,HGIN)患者5例。碘染色诊断早期食管癌的灵敏度为87.50%,特异度为95.83%,准确度为92.50%。碘染色诊断食管LGIN的灵敏度为92.86%,特异度为92.31%,准确度为92.50%。碘染色诊断食管HGIN的灵敏度为80.00%,特异度为94.29%,准确度为92.50%。结论:内镜下碘染色在早期食管癌及癌前病变中诊断效能较好,可有效发现病变,为临床诊疗提供可靠资料。

内镜下黏膜剥离术治疗消化道早期癌及癌前病变的临床效果

目的探讨消化道早期癌及癌前病变患者给予内镜下黏膜剥离术治疗的效果。方法回顾性选取2021年1—12月龙岩市第二医院消化内科接受手术治疗的102例消化道早期癌及癌前病变患者的临床资料,按照临床手术干预方法分为两组,每组51例。对照组采取内镜下黏膜切除术治疗,观察组采取内镜下黏膜剥离术治疗。比较两组患者的手术切除情况、手术指标、并发症发生率和生活质量评分。结果治疗后,观察组的治愈性切除率为84.31%,整块切除率为96.08%,完整切除率为92.16%,均高于对照组的62.75%、78.43%、74.51%,差异有统计学意义(χ^(2)=6.095、7.141、5.718,P均<0.05)。观察组的近期、远期并发症发生率均低于对照组,差异有统计学意义(P均<0.05)。观察组术后3、6、12个月的生活质量评分均高于对照组,差异有统计学意义(P均<0.05)。结论采取内镜下黏膜剥离手术治疗能够提高切除效果,降低并发症发生率,提高患者的生活质量。

放大内镜在ESD治疗食管早期癌及癌前病变中的作用

目的 研究与分析放大内镜在内镜下黏膜剥离术(ESD)治疗食管早期癌及癌前病变中的作用。方法选取2020年1月—2022年7月我院收治的明确诊断为食管癌的患者为观察对象,研究者为其一级亲属40岁以上经普通内镜发现食管异常病灶同时行放大内镜检查者。据疑病处食管黏膜上皮乳头内毛细血管袢(IPCL)变化,判断病变性质估计侵犯深度。疑早期食管癌及癌前病变者行ESD治疗,疑进展期食管癌者行外科手术治疗,送整体标本病理检查。结果 食管癌一级亲属40岁以上患者经普通内镜发现食管异常病灶同时行放大内镜检查者共128例,其中行ESD和外科手术取得整体病理标本102例。对比放大胃镜术前判断和术后整体病理标本,判断性质方面放大内镜对食管早期病变诊断的总体准确率为87.3%,诊断食管早期鳞癌的灵敏度为97.8%,特异度为15.4%,阳性预测值88.8%,阴性预测值50%。判断浸润层次方面,放大内镜对食管早期鳞癌深度诊断的总体准确率为69%,B1型血管对浸润深度正确诊断率为90.6%,灵敏度为70.6%,B2型血管对浸润深度正确诊断为32.2%,灵敏度为76.9%,B3型血管对浸润深度正确诊断为66.7%,灵敏度为33.3%。结论 放大内镜在ESD下治疗食管早期鳞癌及癌前病变患者,可对食管病变性质准确判断,提升病变检出率,实践价值较高。

基于舌象大数据的早期食管鳞癌中医证候转化规律分析

目的将食管癌高发区舌象筛查与内镜筛查相结合,分析食管癌变过程中不同病理状态下舌象特征,探索食管癌前病变向早期食管鳞癌转化的舌象特征规律及中医病机特点。方法纳入河北磁县、四川盐亭、山西阳城地区2017年—2021年完成内镜筛查及舌象筛查的18954例人群,使用道生舌诊仪(DS01-B)在统一标准的光源环境下提取12种舌象特征。使用SPSS 24.0软件进行数据分析,并通过多因素Logistic回归对多种混杂因素进行控制,比较食管癌前病变及早期食管癌与病理正常人群之间的舌象特征差异。结果舌象分布分析显示,紫舌在食管癌前病变及早期食管癌组的比例高于病理正常组,且其在早期食管癌组的比例高于食管癌前病变组,Logistic回归分析结果显示紫舌在食管癌前病变及早期食管癌组的OR值分别为1.82(95%CI:1.45~2.28,P<0.001)、2.14(95%CI:1.51~3.05,P<0.001);红舌与裂纹舌主要在癌前病变组占比较高,其在早期食管癌组的比例略低于癌前病变组,Logistic回归分析结果显示其OR值分别为1.44(95%CI:1.25~1.66,P=0.003)、1.49(95%CI:1.30~1.72,P<0.001)。将其他差异具有统计学意义的舌象特征纳入多因素Logistic回归分析后,结果与前面分析相一致。结论食管癌前病变组紫舌、红色与裂纹舌的比例均高于病理正常组,而早期食管癌组紫舌的比例高于食管癌前病变组,红色与裂纹舌的比例略低于食管癌前病变组,反映出食管癌变过程中由阴虚燥热向瘀血内阻转化的中医病机规律。

miR-421和miR-196b-3p在胃癌癌前病变和早期胃癌诊断中的潜在价值

目的研究血浆miR-421和miR-196b-3p作为诊断胃癌癌前病变和早期胃癌新型潜在生物标志物的临床意义。方法(1)发现集:于2018年12月1日至12月31日采集早期胃癌患者(早期胃癌组)、癌前病变患者(癌前病变组)和健康志愿者(NC组)的血浆标本各3例,用作miRNA微阵列分析。借用TCGA数据证实候选miRNA在癌症组织中的表达。(2)验证集:于2019年1月1日至2023年1月1日共采集90例胃癌患者(胃癌组)、89例癌前病变患者(癌前病变组)和45例健康志愿者(NC组)的血浆标本。通过定量实时聚合酶链反应测定候选miRNA水平。比较各组候选miRNA及常规肿瘤标志物[铁蛋白、甲胎蛋白(AFP)、癌胚抗原(CEA)、CA211、CA50、CA125、CA199、CA153、CA242、CA724]水平;通过受试者工作特征(ROC)曲线分析比较候选miRNA与常规肿瘤标志物的诊断价值。结果(1)发现集:通过miRNA微阵列筛选,与NC组相比,miR-421和miR-196b-3p水平在早期胃癌组和癌前病变组明显上调(P<0.05)。TCGA数据证实,与正常胃黏膜相比,miR-421在胃癌组织中呈高表达(P<0.001)。(2)验证集:与NC组相比,癌前病变组和胃癌组血浆miR-421、miR-196b-3p水平明显上调(P<0.05),且胃癌组血浆miR-421、miR-196b-3p水平高于癌前病变组(P<0.001)。ROC曲线分析结果显示,血浆miR-421对胃癌的诊断价值最高,曲线下面积(AUC)为0.931(95%CI:0.889~0.972),高于CEA、CA125、CA199、CA724、CA211、CA50诊断胃癌的AUC(P<0.05);miR-196b-3p诊断胃癌的AUC[0.804(95%CI:0.733~0.875)]也高于CEA、CA125、CA199和CA724诊断胃癌的AUC(P<0.05);miR-421和miR-196b-3p也可用于早期胃癌诊断,AUC分别为0.942(95%CI:0.886~0.997)和0.809(95%CI:0.708~0.910);血浆miR-421和miR-196b-3p诊断癌前病变的AUC分别为0.788(95%CI:0.714~0.863)和0.648(0.556~0.741),miR-421诊断癌前病变的AUC均高于miR-196b-3p、铁蛋白、CA50诊断癌前病变的AUC(P<0.05)。血浆miR-421和miR-196b-3p在胃癌Ⅰ期病例中的水平与Ⅱ、Ⅲ/Ⅳ期相比,差异无统计学意义(P>0.05),但在胃癌发病早期(Ⅰ~Ⅱ期)的水平明显高于NC组和癌前病变组(P<0.05)。结论血浆miR-421和miR-196b-3p在早期胃癌患者中过表达,有希望成为诊断癌前病变和早期胃癌的新型生物标志物。

早期胃癌及癌前病变内镜黏膜下剥离术术后出血的危险因素分析

目的探讨早期胃癌及癌前病变内镜黏膜下剥离术术后出血的危险因素。方法回顾性分析2019年11月至2022年12月在扬州市江都人民医院消化科收治的90例进行内镜黏膜下剥离术的早期胃癌及癌前病变患者的临床资料,根据是否术后出血,将患者分为出血组和未出血组,对两组患者的临床资料进行单因素分析,并将有统计学意义的变量纳入多因素回归分析,并绘制受试者工作特征(ROC)曲线及森林图。结果共纳入90例患者,其中10例患者术后出血,无出血患者80例。出血组和未出血组在年龄、性别、家族史、饮酒史、吸烟史、糖尿病史、阿司匹林服药史、二甲双胍服药史、浸润程度、病变部位、手术时间、血红蛋白(Hb)、血小板计数(PLT)、癌胚抗原(CEA)等方面比较差异无统计学意义(P>0.05),在高血压史、病灶个数、病变大小、创面处理方式、白蛋白(Alb)等方面比较差异有统计学意义(P<0.05)。多因素回归分析显示,有高血压病史、病变大小≥2 cm、未使用止血夹处理是早期胃癌及癌前病变内镜黏膜下剥离术术后出血的独立危险因素(P<0.05),Alb高水平是早期胃癌及癌前病变内镜黏膜下剥离术术后出血的保护因素(P<0.05)。采用R3.6.2软件进行ROC曲线分析,结果显示多因素联合预测曲线下面积最大(AUC=0.880,95%CI:0.748~1.000)。结论有高血压病史、病变大小≥2 cm、未使用止血夹处理是早期胃癌及癌前病变内镜黏膜下剥离术术后出血的危险因素,以上因素的存在可能增加术后出血的风险,应在治疗中加以重视并采取相应的预防措施。