Real-life chromoendoscopy for dysplasia surveillance in ulcerative colitis

AIM To evaluate the use of chromoendoscopy for surveillance of ulcerative colitis in a real-life community hospital setting.METHODS Patients with extensive ulcerative colitis, having disease duration of more than 8 years and who presented between the years of 1999 to 2013, were offered enrolment in this single cohort prospective study. All participants underwent standard bowel preparation with sodium phosphate and chromoendoscopy. Two expert endoscopists, novice to chromoendoscopy, evaluated each segment of the colon with standarddefinition colonoscopes after spray application of 0.4% indigo carmine. All observed lesions were recorded and evaluated before being removed and/or biopsied. In addition, nontargeted biopsies were taken from each segment of the colon. The dysplasia detection rate and dysplasia detection yield were ascertained. RESULTS A total of 21 neoplastic lesions(2 carcinomas, 4 of high-grade dysplasia and 15 of low-grade dysplasia) and 27 nondysplastic lesions were detected in 16 of the total 67 patients(70% male; median disease duration: 17 years; median age at diagnosis: 25 years; 92% aminosalicylate-treated). The dysplasia detection rate was 10.5%(7/67 patients). The dysplasia detection yield was 20.8%(10/48) for targeted biopsies and 3.5%(11/318) for nontargeted biopsies. The sensitivity and specificity for the macroscopic evaluation of neoplasia using chromoendoscopy were 48% [95% confidence interval(CI): 26%-70%] and 96%(95%CI: 93%-98%), respectively. The positive predictive and negative predictive values were 42%(95%CI: 27%-59%) and 97%(95%CI: 95%-98%), respectively. A total of 19/21 dysplastic lesions were detected in mucosa with histologic inflammation.CONCLUSION Chromoendoscopy seems to be of value for dysplasia surveillance of ulcerative colitis in a community hospital setting. The yield of non-targeted biopsies is negligible.

Adherence to surveillance guidelines for dysplasia and colorectal carcinoma in ulcerative and Crohn's colitis patients in the Netherlands

AIM: To study adherence to the widely accepted surveillance guidelines for patients with long-standing colitis in the Netherlands. METHODS: A questionnaire was sent to all 244 gastroenterologists in the Netherlands. RESULTS: The response rate was 63%. Of all gastroenterologists, 95% performed endoscopic surveillance in ulcerative colitis (UC) patients and 65% in patients with Crohn's colitis. The American Gastroenterological Association (AGA) guidelines were followed by 27%, while 27% and 46% followed their local hospital protocol or no specific protocol, respectively. The surveillance was correctly initiated in cases of pancolitis by 53%, and in cases of left-sided colitis by 44% of the gastroenterologists. Although guidelines recommend 4 biopsies every 10 cm, less than 30 biopsies per colonoscopy were taken by 73% of the responders. Only 31%, 68% and 58% of the gastroenterologists referred patients for colectomy when low-grade dysplasia, high-grade dysplasia (HGD) or Dysplasia Associated Lesion or Mass (DALM) was present, respectively. CONCLUSION: Most Dutch gastroenterologists performendoscopic surveillance without following international recommended guidelines. This practice potentially leads to a decreased sensitivity for dysplasia, rendering screening for colorectal cancer in this population highly ineffective.

Efficacy of various endoscopic modalities in detecting dysplasia in ulcerative colitis:A systematic review and network meta-analysis

BACKGROUND Longstanding ulcerative colitis(UC)is associated with an increased risk of colonic neoplasia.Various endoscopic modalities,such as chromoendoscopy(CE),narrow band imaging(NBI)and random biopsy have been introduced for surveillance,however,there exists a paucity of direct comparisons between them.We aimed to conduct a network meta-analysis of randomized controlled trials(RCTs)performed for surveillance of neoplasia in UC.AIM To provide a comparative evaluation of the efficacy of the above-mentioned various modalities.METHODS We searched MEDLINE/PubMed,Web of Science,Embase,Google Scholar and Cochrane Central Registry through May 2016 for RCTs evaluating the efficacy of endoscopic modalities for surveillance of neoplasia in UC.The primary outcomes of interest were dysplasia(low-or high-grade)detection rates per biopsy and per patient,and dysplasia numbers per patient.Studies were simultaneously analyzed using a random-effects network meta-analysis under the Bayesian framework to identify the modality with the highest dysplasia detection rate.The best ranking probability for the dysplasia detection rate was analyzed by surface under the cumulative ranking(SUCRA)technique.RESULTS Six prospective RCTs of a total 1038 patients were identified.We identified 4 different modalities;white light(WL)high definition(HD)or standard definition(SD),CE HD,and NBI HD.For dysplasia per biopsy,direct meta-analysis showed superiority of NBI HD over WL HD and CE HD over WL SD.Network meta-analysis demonstrated the rank order of best modality as NBI HD,CE HD,WL HD and WL SD with close SUCRA scores of the first two.For dysplasia per patient,direct meta-analyses showed equivocal results between each modality.Network meta-analysis demonstrated the rank order of best modality as WL HD,NBI HD,CE HD and WL SD with small differences of the SUCRA score among the first two.For dysplasia numbers per patient,direct meta-analysis showed superiority of CE HD over WL SD.Network meta-analysis demonstrated the rank order of best modality as WL HD,NBI HD,CE HD,and WL SD with small differences of the SUCRA score among the first three.CONCLUSION We demonstrated that there were small differences among WL HD,NBI HD,and CE HD,while WL SD was inferior,in detecting dysplasia in UC.

Expression of interleukin-22/STAT3 signaling pathway in ulcerative colitis and related carcinogenesis

AIM:To investigate the expression of interleukin (IL)-22 and its related proteins in biopsy specimens from patients with ulcerative colitis (UC) and UC-related carcinogenesis. METHODS:Biopsy specimens were obtained from patients with inactive (n = 10), mild-to-moderately active (n = 30), severely active (n = 34), initial (n = 30), and chronic UC (n = 44), as well as UC patients with dysplasia (n = 10). Specimens from patients without colonic abnormalities (n = 20) served as controls. Chronic colitis in experimental mice was induced by 2.5% dextran sodium sulfate. The expression levels of IL-22, IL-23, IL-22R1 and phosphorylated STAT3 (p- STAT3) were determined by immunohistochemistry. Bcl-2, cyclin D1 and survivin expression was detected by Western blotting. RESULTS:Patients with active UC had significantly more IL-22, IL-23, IL-22R1 and p-STAT3-positive cells than the patients with inactive UC and normal controls. Furthermore, IL-22 and related proteins were closely related to the severity of the colitis. The expression of IL-22 and IL-22R1 in the tissue of initial UC was stronger than in that of chronic UC, whereas the expression of p-STAT3 was significantly increased in chronic UC tissues. In dysplasia tissues, the expression level of IL-22 and related proteins was higher compared with controls. Mouse colitis model showed that expression of IL-22, IL-22R1 and IL-23 was increased with time, p-STAT3 and the downstream gene were also remarkably upregulated.CONCLUSION:IL-22/STAT3 signaling pathway may be related to UC and UC-induced carcinogenesis and IL-22 can be used as a biomarker in judging the severity of UC.

Ulcerative colitis-associated colorectal cancer

The association between ulcerative colitis(UC) and colorectal cancer(CRC) has been acknowledged. One of the most serious and life threatening consequences of UC is the development of CRC(UC-CRC). UC-CRC patients are younger, more frequently have multiple cancerous lesions, and histologically show mucinous or signet ring cell carcinomas. The risk of CRC begins to increase 8 or 10 years after the diagnosis of UC. Risk factors for CRC with UC patients include young age at diagnosis, longer duration, greater anatomical extent of colonic involvement, the degree of inflammation, family history of CRC, and presence of primary sclerosing cholangitis. CRC on the ground of UC develop from non-dysplastic mucosa to indefinite dysplasia, lowgrade dysplasia, high-grade dysplasia and finally to invasive adenocarcinoma. Colonoscopy surveillance programs are recommended to reduce the risk of CRC and mortality in UC. Genetic alterations might play a role in the development of UC-CRC. 5-aminosalicylates might represent a favorable therapeutic option for chemoprevention of CRC.

Ulcerative colitis: From inflammation to cancer. Do estrogen receptors have a role?

Ulcerative colitis(UC) is a condition at increased risk for colorectal carcinoma(CRC) development. Nowadays, screening and follow-up programs are routinely performed worldwide to promote the early detection of CRCs in subjects with well known risk factors(extent, duration and severity of the disorder). The diffusion of these procedures is presumably the main reason for the marked reduction of cancer incidence and mortality in the course of UC. In addition, chemoprevention has been widely investigated and developed in many medical fields, and aspirin has shown a preventive effect against CRC, while mesalazine has been strongly invoked as a potential chemopreventive agent in UC. However, available studies show some limitations due to the obvious ethical implications of drug withdrawal in UC in order to design a control group. The estrogenreceptors(ER) alpha/beta balance seems to have a relevant influence on colorectal carcinogenesis and ER beta appears to parallel apoptosis, and hence an anticarcinogenic effect. Phytoestrogens are compounds acting as ER beta agonists and have shown a promising chemopreventive effect on sporadic as well as genetically inherited CRC. There is evidence suggesting a role for ERs in UC-related carcinogenesis. In this perspective, since these substances can be considered as dietary supplements and are completely free from side effects, phytoestrogens could be an interesting option for CRC prevention, even when the disease is a consequence of long-term chronic inflammation, as in the course of UC. Further studies of their effects are warranted in both the basic research and clinical fields.

Histological healing favors lower risk of colon carcinoma in extensive ulcerative colitis

AIM: To search for the answer in extensive ulcerative colitis as to whether histological inflammation persisting despite endoscopic mucosal healing serves to increase the risk of colon cancer (CC) or high grade dysplasia (HGD).

Lethal neuroendocrine carcinoma in ulcerative colitis

A 48-year old male with longstanding and extensive pancolitis developed a high grade and rapidly lethal malignant lesion in the ascending colon characterized by a neuroendocrine carcinoma.Prior biopsies obtained from multiple sites in the colon during endoscopic surveillance were reported to show only inflammatory changes without dysplasia.Although operator-dependent,repeated endoscopic studies may have limitations during surveillance programs because the biological behavior of some colonic neoplastic lesions may have a rapid and very aggressive clinical course.

Colorectal cancer and dysplasia in inflammatory bowel disease

Both ulcerative colitis and Crohn’s disease carry an increased risk of developing colorectal cancer. Established risk factors for cancer among patients with inflammatory bowel disease (IBD) include the younger age at diagnosis, greater extent and duration of disease, increased severity of inflammation, family history of colorectal cancer and coexisting primary sclerosing cholangitis. Recent evidence suggests that current medical therapies and surgical techniques for inflammatory bowel disease may be reducing the incidence of this complication. Nonetheless heightened vigilance and a careful, comprehensive approach to prevent or minimize the complications of invasive cancer are warranted in this unique cohort of patients. Current guidelines for the prevention and early detection of cancer in this high risk population are grounded in the concept of an inflammation-dysplasia- carcinoma sequence. A thorough understanding of the definition and natural history of dysplasia in IBD, as well as the challenges associated with detection and interpretation of dysplasia are fundamental to developing an effective strategy for surveillance and prevention, and understanding the limitations of the current approach to prevention. This article reviews the current consensus guidelines for screening and surveillance of cancer in IBD, as well as presenting the evidence and rationale for chemoprevention of cancer and a discussion of emerging technologies for the detection of dysplasia.

Screening and surveillance methods for dysplasia in inflammatory bowel disease patients:Where do we stand?

Patients with long-standing ulcerative colitis(UC) and extensive Crohn's colitis(CC) are at increased risk for dysplasia and colorectal cancer(CRC). Several studies have shown that UC extending proximal to the rectum, CC involving at least 1/3 of the colon, co-existence of primary sclerosing cholangitis, undetermined or unclassified colitis, family history of CRC and young age at diagnosis appear to be independent risk factors for inflammatory bowel disease(IBD)-related CRC. Therefore, screening and surveillance for CRC in IBD patients is highly recommended by international and national guidelines, whilst colonoscopy remains the unequivocal tool in order to detect potentially resectable dysplastic lesions or CRC at an early stage. Although the importance of screening and surveillance is widely proven, there is a controversy regarding the time of the first colonoscopy and the criteria of who should undergo surveillance. In addition, there are different recommendations among scientific societies concerning which endoscopic method is more efficient to detect dysplasia early, as well as the terminology for reporting visible lesions and the management of those lesions. This article concisely presents the main endoscopic methods and techniques performed for detecting dysplasia and CRC surveillance in patients with IBD focusing on their evidence-based accuracy and efficiency, as well as their cost-effectiveness. Finally, newer methods are mentioned, highlighting their applicability in daily endoscopic practice.

Influence of SCENIC recommendations on terminology used for histopathologic diagnosis of inflammatory bowel disease-associated dysplasia

BACKGROUND Published in 2015,the International Consensus Recommendations on Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients(SCENIC)recommended abandoning the use of diagnostic term“dysplasia-associated lesion or mass(DALM)”for polypoid dysplastic lesions detected in patients with inflammatory bowel disease(IBD).The aim of this study was to investigate whether this recommendation had any influence on diagnostic terminologies used by pathologists in their practice.METHODS We retrospectively reviewed all pathology reports for surveillance colonoscopic biopsies from ulcerative colitis(UC)patients in our institution during 1/2012-12/2014(pre-SCENIC)and 1/2016-12/2018(post-SCENIC).These included 1203 biopsies from 901 UC patients during the pre-SCENIC period and 1273 biopsies from 977 UC patients during the post-SCENIC period.Their corresponding endoscopic findings and histopathologic diagnoses were recorded.Clinical indications for total colectomy for UC patients and corresponding histopathologic findings in colectomy specimens were also recorded and compared.RESULTS A total of 347 and 419 polyps/polypoid lesions were identified during the preSCENIC and post-SCENIC periods,among which 60 and 104 were dysplastic/adenomatous,respectively.More polypoid dysplastic lesions were simply diagnosed as“adenoma”during the post-SCENIC period in comparison with the pre-SCENIC period(97.1%vs 65.0%;P<0.001).The number of cases with a comment in pathology reports regarding the distinction between DALM and sporadic adenoma was also significantly decreased during the post-SCENIC period(5.8%vs 38.3%;P<0.001).In addition,the term“dysplasia”was more consistently used for random biopsies during the post-SCENIC period.Furthermore,the terms“sessile serrated adenoma/polyp”(SSA/P)and“serrated epithelial change”(SEC)were more consistently used for polypoid lesions and random biopsies,respectively,during the post-SCENIC period,although these were not specifically addressed in the SCENIC recommendations.The indications for colectomy remained unchanged,however,despite the standardization of diagnostic terminologies.CONCLUSION The SCENIC recommendations relieve pathologists from the burden of distinguishing DALM from sporadic adenoma in IBD patients,which helps the standardization of diagnostic terminologies used by pathologists.The consistent use of the diagnostic terminologies may help reduce potential confusions to clinicians and patients.

Chromoendoscopy with targeted biopsies is superior to white-light endoscopy for the long-term follow-up detection of dysplasia in ulcerative colitis patients:a multicenter randomized-controlled trial

Background:Data from single-center experience or small sample-sized studies have shown that chromoendoscopy(CE)might be superior to white-light endoscopy(WLE)for dysplasia surveillance in ulcerative colitis(UC)patients.We performed a prospective randomized trial with a long-term follow-up to compare the detection rate of dysplasia among WLE with targeted biopsies(WLT),WLE with random biopsies(WLR),and dye-based CE with targeted biopsies(CET)in UC patients.Methods:Patients with long-standing UC were enrolled from 11 medical centers from March 2012 to December 2013 and randomized into three arms(WLT,WLR,and CET).Only high-definition endoscopy was used in all three groups.The patients were followed up by annual endoscopy with biopsies through December 2017.Results:With a median follow-up time of 55 months,a total of 122 patients with 447 colonoscopies were finally analysed in the per-protocol set:WLT(n=43),WLR(n=40),and CET(n=39).A total of 34 dysplastic lesions were found in 29 colonoscopies of 21 patients.WLR and CET could identify more colonoscopies that diagnosed dysplasia than WLT(8.1%and 9.7%vs 1.9%;P=0.014 and 0.004,respectively).WLR obtained more biopsied samples than WLT and CET(16.465.1 vs 4.361.4 and 4.361.4;both P<0.001).During the second half of the follow-up(37-69 months),CET could identify more colonoscopies that diagnosed dysplasia than WLT(13.3%vs 1.6%,P=0.015)and showed a trend for increasing the detection rate compared with WLR(13.3%vs 4.9%,P=0.107).Conclusions:For a better outcome of cancer/dysplasia surveillance in patients with long-standing UC,CET appeared to be more effective thanWLT and less tedious than WLR.CET was found to be particularly useful when a long-term(>3 years)follow-up was conducted for dysplasia surveillance.The trial was registered on www.chictr.org.cn(ChiCTR1900023689).

溃疡性结肠炎相关腺瘤和结直肠癌回顾性临床病例分析

背景:研究表明溃疡性结肠炎(UC)患者发生结直肠癌的风险明显增加。目的:总结UC相关腺瘤和UC相关结直肠癌(UcCRC)的发病概况和临床病理特点。方法:选取2000年1月～2012年3月南京军区南京总医院住院确诊的UC患者603例,对其中UC相关腺瘤和UcCRC患者的性别、年龄、病程、临床症状、病理表现等临床资料进行回顾性分析经。结果:603例UC患者中,UC相关腺瘤28例,发病率为4.6%(28/603);UcCRC 4例,发病率为0.7%(4/603)。UC相关腺瘤患者的UC中位病程为3年,UcCRC患者的UC中位病程为29年。UC相关腺瘤好发部位依次为直肠/乙状结肠(16处)、降结肠(7处)、横结肠(6处)、升结肠以及回盲部(4处),UcCRC发病部位分别为升结肠(1例)、降结肠(2例)、乙状结肠(1例)。UC相关腺瘤和UcCRC的临床症状与一般UC相似。结论:UC相关腺瘤和UcCRC的发病率随UC病程的延长而增加。长期病程的UC患者应定期行结肠镜检查,对预防和早期检出结直肠癌具有积极意义。

溃疡性结肠炎患者随访期间异型增生发生率及危险因素分析

目的观察溃疡性结肠炎(UC)患者随访期间异型增生发生率及危险因素。方法前瞻性纳入西安交通大学第一附属医院收治的UC患者332例,于患者出院后持续随访1年,随访期间观察异型增生发生情况,将332例UC患者中发生异型增生者分为增生组,未发生异型增生者分为未增生组。统计两组性别、年龄、病程、身体质量指数(BMI)、高血压、糖尿病、冠心病、吸烟史、饮酒、辛辣饮食、油腻饮食、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、白介素-6(IL-6)、白介素-8(IL-6)、肿瘤坏死因子-α(TNF-α)、黏膜炎症程度、结直肠癌家族史、蒙特利尔分型(左半结肠型、广泛结肠型)、合并原发性硬化性胆管炎(PSC)各项信息。对比增生组和未增生组基础资料差异,将有差异的单因素息纳入Logistic模型,行量化赋值,明确UC患者随访期间异型增生发生的危险因素。结果332例UC患者中,随访期间发生异型增生的有37例,异型增生发生率为11.14%。增生组年龄≥50岁、诊断年龄<30岁、吸烟史、辛辣饮食、油腻饮食、中重度黏膜炎症、广泛结肠型患者占比显著高于未增生组,IL-6、IL-8、TNF-α水平显著高于未增生组(P均<0.05)。多因素Logistic回归分析显示,年龄≥50岁、诊断年龄<30岁、吸烟史、辛辣饮食、油腻饮食、IL-6≥40.23 ng/L、IL-8≥40.23 ng/L、TNF-α≥40.23 ng/L、中重度黏膜炎症、广泛结肠型是UC患者随访期间异型增生发生的独立危险因素(P均<0.05)。结论UC患者治疗后异型增生发生率较高,约为11%,其中年龄较大、诊断年龄较小、吸烟史、辛辣饮食、油腻饮食、血清炎症因子水平较高、中重度黏膜炎症、广泛结肠型的患者发生异型增生可能性较高,临床应加强对具有以上特征患者的癌变监测。

溃疡性结肠炎相关性结直肠癌的危险因素及预防

溃疡性结肠炎是一种直肠及结肠的慢性非特异性炎症性疾病,临床以反复发作的腹泻、腹痛和黏液脓血便为特征。溃疡性结肠炎相关性结直肠癌是溃疡性结肠炎严重的并发症及重要死亡原因,其危险因素包括病程、病变范围、原发性硬化性胆管炎、结直肠癌家族史、发病年龄及炎症严重程度等。不典型增生是溃疡性结肠炎相关性结直肠癌发生的重要环节,早期发现不典型增生,积极化学预防是预防溃疡性结肠炎癌变的关键。

溃疡性结肠炎中腺瘤样和非腺瘤样异型增生相关性病变或肿块

溃疡性结肠炎(UC)患者罹患结直肠癌(CRC)的风险较高。UC相关的异型增生分两种,即腺瘤样(adenoma-like)异型增生相关性病变或肿块(DALM)和非腺瘤样(non-adenoma-like)DALM,后者因恶变风险高,常被建议结肠切除治疗。然而,非腺瘤样DALM与腺瘤样DALM在白光内镜下的表现极其相似,近年来发展了多种内镜新技术有利于两者的鉴别。

慢性溃疡性结肠炎大鼠结肠黏膜异型增生模型探讨

目的探讨慢性溃疡性结肠炎大鼠黏膜异型增生模型的建立方法。方法采用2种方法制备模型。二甲肼(DMH)刺激法:三硝基苯磺酸(TNBS)经直肠制备结肠炎模型后采用皮下注射DMH刺激造模;TNBS持续刺激法:TNBS经直肠诱导结肠炎2周后,采用尾静脉注射TNBS刺激,造模周期10周。结果模型组动物前期均出现腹泻、脓血黏液便,造模10周后模型大鼠结肠黏膜可见瘢痕、粘连,结肠长度缩短;血清中TNF-α、IL-6浓度较正常组动物显著增高;病理观察可见模型大鼠结肠黏膜均有不同程度的炎症表现:上皮细胞结构改变,淋巴细胞浸润,血管充血;肌层增厚;杯状细胞消失,腺体排列紊乱,异型增生出现。结论该模型可模拟结肠慢性炎症到异型增生这一病理变化过程。

LRP-5、LRP-6在溃疡性结肠炎相关癌组织中表达的临床意义

目的:探讨脂蛋白受体相关蛋白5、6(LRP-5、LRP-6)在溃疡性结肠炎(UC)相关癌组织中的表达及意义.方法:以溃疡性结肠炎伴不典型增生(UD)和溃疡性结肠炎相关癌(UCAC)为病例组,溃疡性结肠炎(UC组)和散发性大肠癌(SCRC组)为对照组,应用免疫组织化学S-P法检测各组肠黏膜组织中LRP-5、LRP-6的表达.结果:5例UCAC中,LRP-5和LRP-6蛋白阳性表达率均明显高于对照组,与对照UC、SCRC比较差异有统计学意义(LRP-5:80.00%vs23.33%,40.00%;LRP-6:80.00%vs16.67%,45.00%,均P<0.01).在15例UD组中,LRP-5和LRP-6蛋白阳性表达分别为14例(93.33%)及13例(86.67%),与对照组UC、SCRC比较差异有统计学意义(P<0.05).结论:LRP-5、LRP-6在UCAC的发病机制中可能起着较重要的作用,并可能作为一个早期生物学标记物来提示瘤变的可能.

p53、KRAS、APC蛋白及Ki-67在溃疡性结肠炎2种中医证型患者中的表达特点

目的探讨脾胃气虚证和湿热内蕴证溃疡性结肠炎(UC)患者肠黏膜活检组织中p53、KRAS、APC蛋白及增殖指数Ki-67的表达特点和意义。方法根据中医辨证分型及有无异型增生将64例UC患者分为脾胃气虚证组23例,湿热内蕴证组22例,脾胃气虚证伴低级别异型增生组9例,湿热内蕴证伴低级别异型增生组10例。选取同期肠镜活检组织呈轻度慢性炎者10例作为正常组,大肠癌患者11例作为大肠癌组。采用免疫组织化学方法检测各组患者肠黏膜组织内p53、KRAS、APC蛋白及Ki-67表达情况。结果UC各组患者肠黏膜组织内p53蛋白表达阳性和Ki-67位于隐窝上1/2者的比例均明显低于大肠癌组(P均<0.05);脾胃气虚证组和湿热内蕴证组p53蛋白表达阳性和Ki-67位于隐窝上1/2者的比例基本相同;脾胃气虚证伴低级别异型增生组p53蛋白表达阳性和Ki-67位于隐窝上1/2者的比例高于湿热内蕴证伴低级别异型增生组,但差异无统计学意义;UC各组患者肠黏膜组织内均未见KRAS蛋白和APC蛋白表达。结论脾胃气虚证伴低级别异型增生患者存在更高比例的肠黏膜上皮p53蛋白过表达及黏膜上皮增生活跃、缺乏成熟现象等癌变危险因素,对于脾胃气虚证伴低级别异型增生患者应加强随访和肠镜监测。

5-氨基水杨酸对炎症性肠病相关性结肠癌和上皮内瘤变化学预防:Meta分析

目的探讨5-氨基水杨酸(5-ASA)对炎症性肠病(IBD)相关性结肠癌(IBDACa)和上皮内瘤变(IBDADys)发生率的影响,评估5-ASA对IBDACa/Dys的化学预防作用。方法检索正式发表的关于5-ASA对IBDACa/Dys化学预防的临床研究。外文数据库包括PubMed(Medline)、EMCC、OVID、the Cochrane Library;中文数据库包括万方、维普、CNKI、谷歌学术搜索。将符合要求的文献利用统计软件RevMan统计OR值和95%CI。对研究设计类型、IBD类型进行亚组分析。结果共纳入14篇文献,其中10篇为病例对照研究,4篇为队列研究。结果显示:与未使用5-ASA相比,使用5-ASA患者的IBDACa和IBDADys发生率为50%,OR=0.50(95%CI:0.34～0.73),其中病例对照研究Meta分析结果示OR=0.30(95%CI:0.10～0.92),队列研究示OR=0.56(95%CI:0.37～0.85);使用5-ASA的溃疡性结肠炎(UC)患者发生UCCa/Dys的OR=0.45(95%CI:0.27～0.77),使用5-ASA的克罗恩病(CD)患者发生CDCa/Dys的OR=0.39(95%CI:0.16～0.97)。结论 5-ASA对IBDACa/Dys有化学预防作用。