Establishment and Characterization of Chronic-hypoxia-resistant Gastric Cancer Cell Line MNK45/HYP

The chronic-hypoxia-resistant gastric cancer cell line was established,and its biological characteristics were explored and compared with the parental cell line.Gastric cancer cell lines were cultured under the degressive oxygen concentration.Cell doubling time was calculated by cell counting method.Chemo-resistance ability of cells was tested by MTT assay.Irradiation tolerance of cells was evaluated by colony forming method.Cell cycle distribution was tested with flow cytometry.Invasive ability was tested by Transwell method.The expression levels of GLUT-1 and HIF-1α were detected by using Western blot.MNK45/HYP cells successfully survived under the 1% concentration of oxygen and its cell doubling time was 35.01±1.02 h,while that of MNK45 was 27.35±0.83 h（P〈0.01）.The percentage of MNK45/HYP cells in G0/G1 stage was（58.3±6.1）%,and that of MNK45 cells was（42.2±6.0）%（P〈0.05）.Comparing with the parental cells MNK45,drug resistance indexes of 5-Fu,PTX,OXA,Sn38,GEM and VP16 in MNK45/HYP cells were respectively 5.3,1.3,3.6,2.2,4.8 and 4.4.Colony forming ability of MNK45/HYP cells after irradiation was also significantly higher than MNK45 cells.The invasive number of MNK45/HYP cells was 107.7±17.5,while that of MNK45 cells was 59.0±9.9.The expression levels of GLUT-1 and HIF-1α in MNK45/HYP cells were significantly higher than those in MNK45 cells.MNK45/HYP cells hold biological characteristics of hypoxia tumor with good tolerance to chronic hypoxia,and can be used for the research of solid tumor under chronic hypoxia condition.

CAMPYLOBACTER-PYLORIDIS INFECTION OF GASTRIC MUCOSA IN THE HIGH AND LOW RISK AREAS OF STOMACH CANCER IN CHINA

Gastric biopsies in 690 subjects from the high and low risk areas of gastric cancer were examined for identification of Cp in the gastric mucosa by Warthin-Starry, Gimenez and Gram' s stains. The result showed that the positive rate was 60-62% in the high risk area whereas it was only 12. 6% in the low risk area in Liaoning province. 80-92% of the positive subjects had active chronic gastritis including chronic superficial and atrophic gastritis. The result Indicates a close correlation between the active chronic gastritis and Cp infection. Therefore, control of the Cp Infection in the gastric mucosa is very important for lowering the incidence of chronic gastritis, a well known precursor of gastric cancer.

Gastric mucosa in Mongolian and Japanese patients with gastric cancer and Helicobacter pylori infection

AIM: To investigate the characteristics of gastric cancer and gastric mucosa in a Mongolian populationby comparison with a Japanese population.METHODS: A total of 484 Mongolian patients with gastric cancer were enrolled to study gastric cancer characteristics in Mongolians. In addition, a total of 208 Mongolian and 3205 Japanese consecutive outpatients who underwent endoscopy, had abdominal complaints, no history of gastric operation or Helicobacter pylori eradication treatment, and no use of gastric secretion inhibitors such as histamine H2-receptor antagonists or proton pump inhibitors were enrolled. This study was conducted with the approval of the ethics committees of all hospitals. The triple-site biopsy method was used for the histologic diagnosis of gastritis and H. pylori infection in all Mongolian and Japanese cases. The infection rate of H. pylori and the status of gastric mucosa in H. pylori-infected patients were compared between Mongolian and Japanese subjects. Age(± 5 years), sex, and endoscopic diagnosis were matched between the two countries.RESULTS: Approximately 70% of Mongolian patients with gastric cancer were 50-79 years of age, and approximately half of the cancers were located in the upper part of the stomach. Histologically, 65.7% of early cancers exhibited differentiated adenocarcinoma, where as 73.9 % of advanced can cersdisplayed undifferentiated adenocarcinoma. The infection rate of H. pylori was higher in Mongolian than Japanese patients(75.9% vs 4 8. 3 %, P<0.0001). When stratified by age, the prevalence was highest among young patients, and tended to decrease in patients aged 50 years or older. The anti-East-Asian Cag Aspecific antibody was negative in 99.4% of H. pyloripositive Mongolian patients. Chronic inflammation, neutrophil activity, glandular atrophy, and intestinal metaplasia scores were significantly lower in Mongolian compared to Japanese H. pylori-positive patients(P < 0.0001), with the exception of the intestinal metaplasia score of specimen from the greater curvature of the upper body. The type of gastritis changed from antrumpredominant gastritis to corpus-predominant gastritis with age in both populations.CONCLUSION: Gastric cancer was located in the upper part of the stomach in half of the Mongolian patients; Mongolian patients were infected with non-East-Asiantype H. pylori.

Identifying high-risk individuals for gastric cancer surveillance from western and eastern perspectives: Lessons to learn and possibility to develop an integrated approach for daily practice

Current evidence shows that individuals with gastric dysplasia, severe and extensive gastric atrophy, extensive gastric intestinal metaplasia and the incomplete subtype of intestinal metaplasia are at high risk for gastric cancer(GC) development. There are several approaches to identifying these subjects,including noninvasive methods, esophagogastroduodenoscopy and histology.The main approach in Western countries is histology-based while that in Eastern countries with a high prevalence of GC is endoscopy-based. Regarding asymptomatic individuals, the key issues in selecting applicable approaches are the ability to reduce GC mortality and the cost-effectiveness of the approach. At present, population-based screening programs have only been applied in a few Asian countries with a high risk of GC. Pre-endoscopic risk assessment based on demographic and clinical features, such as ethnicity, age, gender, smoking and Helicobacter pylori status, is helpful for identifying subjects with high pre-test probability for a possibly cost-effective approach, especially in intermediate-and low-risk countries. Regarding symptomatic patients with indications for esophagogastroduodenoscopy, the importance of opportunistic screening should be emphasized. The combination of endoscopic and histological approaches should always be considered as endoscopy provides a real-time assessment of the patient’s risk level. In addition, imaging enhanced endoscopy(IEE) has been shown to facilitate targeted biopsies resulting in better correlation between endoscopic and histological findings. Currently, the use of IEE is recommended for endoscopic examinations, and the Operative Link for Gastric Intestinal Metaplasia or Operative Link on Gastritis Assessment grading systems are recommended for histological examinations whenever available. However,resource limitations are an important barrier in many regions worldwide. Thus,for an approach to be applicable in real-life practice, it should be not only evidence-based but also resource-sensitive. In this review, we discuss the current understanding and approaches to identifying high-risk individuals from western and eastern perspectives, as well as the possibility of an integrated, resourcesensitive approach.

Endoscopic submucosal dissection in early gastric cancer in elderly patients and comorbid conditions

The prognosis of early gastric cancer(EGC) is good if there is no concomitant lymph node metastasis. Therefore, the early detection of EGC is important to improve the prognosis of patients with gastric cancer. In Japan, 40% to 50% of all gastric cancers are EGC, and endoscopic submucosal dissection(ESD) is widely accepted as a local treatment for these lesions, particularly for large lesions that at one time were an indication for gastrectomy because of the difficulty of en-bloc resection. Consequently, this procedure can preserve the entire stomach and the patient's postoperative quality of life. ESD has become a general technique with improved procedures and devices, and has become the preferred treatment for EGC rather than gastrectomy. Therefore, ESD may demonstrate many advantages in patients who have several comorbidities, particularly elderly population, patients taking antithrombotic agents, or patients with chronic kidney disease, or liver cirrhosis. However, it is not yet clear whether patients with both EGC and comorbidities are feasible candidates for ESD and whether they would consequently be able to achieve a survival benefit after ESD. In this review, we discuss the clinical problems of ESD in patients with EGC and those comorbid conditions.

胃癌与慢性萎缩性胃炎胃黏膜SLC26A9基因表达情况分析

目的分析胃癌与慢性萎缩性胃炎(CAG)胃黏膜SLC26A9基因表达情况。方法回顾性分析200例过往CAG入院复查患者,以其中69例CAG患者为胃炎组,40例胃黏膜低级别上皮细胞瘤变患者为低级别瘤变组,34例胃黏膜高级别上皮细胞瘤变患者为高级别瘤变组,57例胃癌患者为胃癌组;胃癌组根据胃癌进展程度分为早期组(n=31)和进展期组(n=26)。200例患者均进行胃黏膜SLC26A9基因表达水平检测,比较胃炎组、低级别瘤变组、高级别瘤变组、胃癌组4组患者胃黏膜SLC26A9基因表达水平;比较早期组和进展期组患者胃黏膜SLC26A9基因表达水平。使用logistic相关性模型分析SLC26A9基因表达水平与胃癌发生、胃癌进展程度的相关性。使用受试者工作曲线(ROC)分析SLC26A9基因表达对胃癌的诊断价值;使用ROC曲线分析SLC26A9基因表达对胃癌进展程度的判断价值。结果胃炎组、低级别瘤变组、高级别瘤变组、胃癌组4组胃黏膜SLC26A9基因表达水平均存在明显差异,且胃炎组>低级别瘤变组>高级别瘤变组>胃癌组(P<0.05);早期组患者胃黏膜SLC26A9基因表达水平显著高于进展期组(P<0.05)。经logistic相关性分析,胃黏膜SLC26A9基因表达水平与胃癌发生、胃癌进展程度均呈负相关(P<0.05)。ROC曲线中,胃黏膜SLC26A9基因表达水平诊断胃癌发生的曲线下面积(AUC)为0.935,95%CI为0.892~0.965,敏感度为91.23%,特异度为87.41%,截断值为0.2787;胃黏膜SLC26A9基因表达水平诊断胃癌进展程度AUC为0.881,95%CI为0.768~0.952,敏感度为92.31%,特异度为80.65%,截断值为0.2368。结论胃黏膜SLC26A9基因表达水平与胃癌发生密切相关,可为临床诊断CAG患者疾病恶化为胃癌及其胃癌进展程度。

趋化因子CXCL5与慢性萎缩性胃炎及胃癌前病变的相关性

目的明确慢性萎缩性胃炎(CAG)及胃癌前病变(PLGC)患者血清及胃组织中CXCL5水平变化情况,并探究CXCL5用于诊断CAG及PLGC的预测价值。方法纳入2022年6月至2023年6月在安徽中医药大学第二附属医院脾胃科收治并行胃镜及病理确诊的CAG 72例,以及同期在我科接受胃镜检查的健康受试者68例。收集所有受试者的临床信息和实验室结果,通过logistic回归分析方法明确CAG的影响因素及CXCL5的诊断价值。此外,为了明确CXCL5在CAG发展进程中的作用,选取2023年6-12月于本院收治的CAG、肠化、异型增生患者各15例,以及健康受试者15例。采用ELISA法、PCR法和免疫组化法验证各组CXCL5的表达情况以及与临床病理程度之间的关系,对CXCL5的诊断效能进行验证评估。结果本病的影响因素包括肿瘤家族史、吸烟史、饮酒史、饮食规律与否、幽门螺杆菌感染、病灶数量、病理程度、胃功能三项、CXCL5等(P<0.05)。受试者工作特征(ROC)曲线显示,曲线下面积(AUC)为1.00,约登指数为0.986,展现了良好的预测能力。ELISA结果显示,与正常组相比,CAG、肠化和异型增生组患者血清CXCL5表达水平显著升高,且与病理程度呈正相关;PCR及免疫组化染色结果显示,与正常组相比,CAG、肠化和异型增生组患者胃组织CXCL5 mRNA及蛋白表达水平均显著升高,且与病理程度呈正相关。结论CXCL5在CAG和PLGC患者血清及胃组织中呈高表达,其表达水平与病理程度呈正相关。因此,CXCL5有望成为诊断CAG及PLGC的预测指标和新的治疗靶点。

从“中焦如衡”论治胃癌前病变

“中焦如衡”是清代医家吴鞠通基于脾胃的生理特点,提出的脾胃病治疗大法。后世医家在此论点基础上,结合大量临床实践不断深化,形成了以“中焦如衡”为切入点的论治脾胃病病因病机与治疗大法为一体的理论体系。胃癌前病变(PLGC)是具有较高癌变风险的病理改变。从“中焦如衡”理论探讨PLGC的病因病机,立足于脾胃的生理病理特点,以“中焦如衡,以平为期”为切入点,认为本病由多种因素叠加导致胃黏膜遭受持续损害,而在正邪交争中,胃黏膜的保护和防御机制被激活,动态平衡机制被打破,出现以脾胃虚损为本、毒瘀损络为要、升降失衡为主要表现的病机特点,随之而出现病理改变和临床表现。通过调和气血、虚实、气机等多种因素,以调和中焦为手段,以恢复脾胃平衡、气机升降为目的,从而防治PLGC。

慢性萎缩性胃炎及癌前病变复合造模法评价

目的 评价复合造模法构建慢性萎缩性胃炎(chronic atrophic gastritis, CAG)及胃癌前病变(precancerous lesions of gastric cancer, PLGC)大鼠模型的可行性。方法 将60只SPF级雄性SD大鼠随机分为对照组(n=10)及模型组(n=50)。对照组正常饲养,模型组用N-甲基-N′-硝基-N-亚硝基胍(MNNG)自由饮用+水杨酸钠隔日灌胃+脱氧胆酸钠隔日灌胃+不定期禁食复合造模法构建慢性萎缩性胃炎大鼠模型,造模时间为6个月。于造模第3,4,5,6个月比较模型组与对照组大鼠胃黏膜病理程度,造模后采血,采用ELISA检测血清胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)及胃泌素17(G-17)。结果 模型组大鼠复合刺激4个月开始出现胃腺体萎缩,5个月出现纤维化,6个月出现胃腺消失及异型增生,1只出现癌变。模型组6只大鼠异常死亡,造模死亡率为12%。与对照组比较,模型组血清PGⅠ升高(P<0.05),PGⅠ与PGⅡ比值(PG R)降低(P<0.05),G-17降低(P<0.05)。结论 采用复合造模法制备大鼠CAG模型成功率高,结果较稳定,但制备时间较长,且由于大鼠个体差异,造模进程难以完全统一,所有大鼠均出现胃黏膜萎缩,部分大鼠出现PLGC特征,个别大鼠出现癌变。

胃癌前病变病证结合动物模型研究进展

中医药在胃癌前病变(precancerous lesions of gastric cancer,PLGC)诊疗中发挥着重要作用,病证结合动物模型是进行PLGC相关实验研究的前提。文章从模型动物选择、胃癌前病变疾病模型和病证结合模型三方面,对近年来PLGC病证结合模型的制备方法进行了归纳分析,介绍了脾胃虚弱、胃阴不足、肝胃气滞、脾胃湿热和胃络瘀血5个常见PLGC病证结合模型的造模方法,并对当前模型制备中存在的问题提出了思考与展望。

从“态靶辨治”角度分析蔡淦治疗脾虚瘀热型胃癌前病变经验

从“态靶辨治”角度介绍蔡淦教授治疗脾虚瘀热型胃癌前病变的经验。认为其基本病机为脾失健运,湿阻热蕴,气滞血瘀胶着于胃腑;临证强调“态靶辨治”,把握“基本态”、紧扣“疾病靶”、把控“症状靶”、参考“指标靶”;治疗时灵活运用经验方莪连颗粒健脾益气、化瘀清热以调态,并通过抗幽门螺杆菌、调节炎症因子及肿瘤指标表达水平、提高机体免疫力、影响相关信号通路等途径“精确打靶”,疗效突出。并附验案1则。

胃蛋白酶原联合中性粒细胞与淋巴细胞比值对慢性萎缩性胃炎患者并发胃癌的预测价值

目的 探究胃蛋白酶原(PG)联合中性粒细胞与淋巴细胞比值(NLR)对慢性萎缩性胃炎(CAG)患者并发胃癌的预测价值。方法 回顾性选取延安大学医学院在2015年3月至2019年3月间收治的460例CAG患者纳入研究,检测患者PG、NLR水平。对患者进行至少5年的随访,观察患者胃癌情况,并将其分为发生组和未发生组。单因素及多因素分析CAG患者发生胃癌的影响因素,受试者工作特征(ROC)曲线下面积分析PG、NLR联合检测对患者发生胃癌的预测价值。结果 单因素分析显示,发生组年龄、幽门螺旋杆菌(Hp)感染阳性占比、伴不典型增生占比、伴肠上皮化生占比、NLR水平高于未发生组,PG水平低于未发生组(P<0.05)。多因素逐步Logistic回归分析显示,伴不典型增生(OR=3.741,95%CI:1.539~9.091)、伴肠上皮化生(OR=4.211,95%CI:1.911~~9.277)、NLR水平(OR=3.823,95%CI:2.186~6.683)是CAG患者发生胃癌的独立危险因素,PG水平(OR=0.212,95%CI:0.102~0.441)是独立保护因素(P<0.05)。ROC曲线显示,PG、NLR及二者联合预测CAG患者发生胃癌的灵敏度分别为67.70%、77.40%、90.30%,特异度分别为79.30%、72.70%、67.80%,AUC分别为0.791、0.814、0.902(P<0.05)。结论 NLR水平是CAG患者发生胃癌的独立危险因素,PG水平是独立保护因素,PG和NLR水平联合测定可较好的预测患者胃癌发生情况。

基于问卷调查联合新型胃癌筛查评分系统对酒仙桥地区人群慢性萎缩性胃炎及胃癌的比较研究

目的探讨问卷调查联合新型胃癌筛查评分系统在北京市酒仙桥地区人群中对慢性萎缩性胃炎及胃癌的诊断效能,重新评估胃镜检查的筛查人群,践行个体化医疗服务,避免医疗资源浪费,初步探讨胃癌预防策略。方法纳入2022年3月至2022年11月因上腹部不适在清华大学第一附属医院(包括协同单位—将台社区、东风社区及高家园社区)就诊的291例患者作为研究对象,通过问卷调查联合新型胃癌筛查评分系统(以下简称综合评分系统)与单独应用新型胃癌筛查评分系统分别开展胃癌初步筛查,结合初筛结果,将人群分为低危组、中危组和高危组,比较三组根据病理结果诊断慢性非萎缩性胃炎、慢性萎缩性胃炎和胃癌的检出率。结果共291例患者参与胃镜检查,应用综合评分系统,低危组156例(53.61%),中危组108例(37.11%),高危组27例(9.28%),在慢性萎缩性胃炎和胃癌的检出率上,高危组明显高于中危组和低危组,差异有统计学意义(P<0.05)。同时ROC分析显示,综合评分系统与单独应用新型胃癌筛查评分系统对慢性萎缩性胃炎和胃癌诊断评估的AUC分别为0.658(0.595~0.721)、0.684(0.622~0.746),敏感度分别为62.22%、63.70%,特异度分别为67.31%、63.70%,阳性预测值分别为0.622、0.652,阴性预测值分别为0.673、0.692;综合评分系统与单独应用新型胃癌筛查评分系统对胃癌诊断评估的AUC分别为0.756(0.583~0.929)、0.717(0.552~0.882),敏感度分别为50.00%、80.00%,特异度分别为92.17%、55.87%;阳性预测值分别为0.179、0.130,阴性预测值分别为0.981、0.974。结论问卷调查联合新型胃癌筛查评分系统在北京市酒仙桥地区人群中对胃癌具有良好的筛查价值,值得临床推广,可为大规模胃癌风险评估体系的建立奠定基础。

基于GEO基因芯片联合网络药理学及分子对接技术探讨参苓脾喜汤治疗慢性胃炎、胃黏膜上皮内瘤变、胃早期癌作用机制

目的 基于GEO基因芯片、网络药理学及分子对接技术探讨参苓脾喜汤防治慢性胃炎(CG)、胃黏膜上皮内瘤变(GIN)、胃早期癌(EGC)的作用机制。方法 从GEO数据库下载含CG、GIN、EGC基因芯片GSE130823,使用R4.1.1筛选共同差异表达基因。利用TCMSP数据库筛选参苓脾喜汤活性成分及对应靶点,使用R4.1.1对共同表达基因与药物靶点取交集,通过Cytoscape3.9.1软件构建中药-活性成分-靶点网络,并通过STRING数据库构建蛋白相互作用(PPI)网络并进行拓扑分析,以筛选核心靶点,使用R4.1.1对交集基因进行GO功能和KEGG通路富集分析。最后将排名靠前的药物活性成分与核心靶点蛋白进行分子对接验证。结果 共筛选出1 115个差异表达基因,参苓脾喜汤活性成分119种,靶点247个,主要活性成分包括槲皮素、豆甾醇、木犀草素等。预测得到参苓脾喜汤治疗CG、GIN、EGC潜在作用靶点22个,包括CHRM3、AR、ADRB2、DPP4等。GO功能和KEGG富集分析结果显示,参苓脾喜汤治疗CG、GIN、EGC主要涉及对cAMP、IL-17、TNF、离子跨膜转运蛋白活性的调节、钙信号通路等方面。分子对接结果显示,木犀草素与ALB、AR、DPP4有较强结合能力,槲皮素与ALB、DPP4有较强结合能力,豆甾醇与AR有较强结合能力。结论 参苓脾喜汤中多种活性成分可能通过cAMP、IL-17、TNF等信号通路,调控ALB、AR、DPP4、CYP3A4等靶点治疗CG、GIN、EGC。

近10年中医辨治胃癌前病变的研究进展

对近10年来有关中医辨治胃癌前病变(precancerous lesions of gastric cancer,PLGC)的研究进行综述。PLGC是指在慢性萎缩性胃炎基础上出现的胃黏膜肠上皮化生和异型增生,作为慢性萎缩性胃炎与胃癌的中间阶段,PLGC的病程较缓慢。中医辨治PLGC具有一定的优势。PLGC主要可分为脾胃虚弱证、脾胃湿热证、肝胃气滞证、胃络瘀阻证、胃阴不足证5种证型。胃镜技术的普及促进了胃病微观辨证的发展,微观辨证与宏观辨证的结合为PLGC的中医辨证论治提供了更加丰富的理论支持。PLGC根本病机为脾胃虚弱,脾胃气机不畅,兼有湿热、瘀毒、痰湿等病理因素蕴结,日久胃阴亏耗。中药治疗PLGC的临床研究开展较多,治疗主要采用以益气健脾为主,兼以疏肝活血、化湿消瘀、化瘀解毒、养阴益胃,从而防止PLGC向胃癌进一步发展。针灸治疗胃癌前病变的研究开展较少。今后需开展更多严格且规范的多中心、大样本的临床随机对照试验,深入研究针灸治疗胃癌前病变机制,以期为中医辨治PLGC提供更多高级别的循证依据。

芪竹健胃方治疗慢性萎缩性胃炎及癌前病变临床研究

目的研究芪竹健胃方治疗脾虚湿热血瘀型慢性萎缩性胃炎及癌前病变的临床疗效,并探讨该方药的作用机制。方法采用自身前后对照研究方法,纳入符合中西医诊断标准的患者31例作为治疗组,予芪竹健胃方中药汤剂进行治疗,疗程12 w,对比治疗前后中医症状疗效、胃镜征象、粘膜病理、癌变风险,血清胃功能三项的变化。另外,用蛋白免疫印迹法检测20例治疗组患者治疗前、治疗后胃粘膜Lgr5、Wnt1、C-myc蛋白表达情况,进行对比分析,对该方的作用机制开展探索性研究。结果治疗12 w后,治疗组患者的中医证候评分、胃镜病理改善情况具有统计学意义(P<0.01),降低癌变风险,血清G17、PGⅠ值升高,有统计学差异(P<0.01),PGR有升高趋势,且具有统计学差异(P<0.05);PGⅡ方面,结果不具统计学差异(P>0.05)。20例治疗组患者治疗前后胃粘膜Lgr5、Wnt1、C-myc蛋白表达情况皆呈逐渐下降的趋势。结论芪竹健胃方能明显改善慢性萎缩性胃炎及胃癌前病变患者的中医证候,促进胃黏膜的修复,降低癌变风险的机制可能与调控Wnt/Lgr5信号通路,抑制Lgr5标记的胃干细胞异常增殖分化有关。

名中医邱健益气活血和中解毒方辨治慢性重度萎缩性胃炎(胃癌前病变)临证体会

邱健主任从事中医临床工作40余年,精研医术,倡导“中和”学术思想。邱主任在辨证论治慢性重度萎缩性胃炎(胃癌前病变)方面有自身独到见解,认为其基本病机为“正虚血瘀,浊毒内蕴”,故以“益气活血,和中解毒”为基本治则,以自拟益气活血和中解毒方为主加减化裁,使方证相符,临床效果显著。

不良嗜好及胃慢性疾病与胃癌

目的：研究吸烟、饮酒等不良嗜好和胃慢性疾病与胃癌的关系。方法：采用病例对照方法对３６１ 例胃癌病例和１ ５２５ 例人群对照的既往暴露史进行回顾性调查，用Ｌｏｇｉｓｔｉｃ 回归模型估计各因素与胃癌的联系强度。结果：经混杂因素调整后，吸烟可以增加胃癌危险性４８％ ，吸烟年限越长、日吸烟量越大、开始吸烟年龄越小其危险性越高。饮酒增加胃癌危险性８２％ ，饮白酒的作用最明显。有胃慢性疾病史者明显增加胃癌危险性，并有随患病年限越长其危险性越大的时间效应关系。吸烟、饮白酒和胃慢性疾病史既是作用很强的独立因素，亦有明显的相乘作用。结论：吸烟、饮酒和胃慢性疾病史是胃癌的主要危险因素，戒除不良嗜好，早期。

不同表型幽门螺杆菌对胃黏膜ki-67表达的影响

目的:探讨不同表型的幽门螺杆菌(Hp)对胃黏膜k i-67表达的影响。方法:对137例经胃镜及组织学检查确诊的Hp(+)慢性胃炎(CG)、消化性溃疡及胃癌患者和34例Hp(-)患者,用W estern b lot检测Hp细胞毒素相关蛋白(CagA)、空泡毒素(VacA)、尿素酶(Urease)及其亚型。评价Hp(+)CG中慢性炎症(C I)、多形核活动性(PA)、Hp定植密度(DH)的组织学等级。用免疫组化检测k i-67的表达。结果:①Hp相对分子质量为128 000CagA、116 000 CagA、95 000VacA、91 000VacA、30 000UreA的表达在轻度C I组的比例低于中、重度C I组(P<0.05),95 000VacA、91 000 VacA和30 000UreA表达在无PA组的比例低于有PA组(P<0.05)。②k i-67标记指数(LI)在慢性胃炎Hp(+)组高于Hp(-)组(P=0.041);在中、重度DH组高于轻度组(P=0.014);在Hp(+)CG中重度C I组高于轻度组(P=0.039),而在Hp(-)CG组则无此关系(P>0.05)。Hp(+)CG中,128 000 CagA、95 000VacA、30 000UreA表达组k i-67LI高于相应不表达组(P<0.05);Hp(+)胃癌者中,128 000 CagA表达组k i-67LI高于相应不表达组(P=0.02)。结论:Hp多种毒力因子对加重胃黏膜C I程度、PA的发生和发展起促进作用,Hp感染及DH增加均促进慢性胃炎胃黏膜上皮细胞增殖,但可能对胃黏膜良恶性病变的促细胞增殖作用有差异,更多毒力因子对慢性胃炎而不是胃癌的细胞增殖起作用。

胃部疾病患者组织和血清中白细胞介素23和胃蛋白酶原1的变化及临床意义

目的探讨胃部疾病患者组织和血清中白细胞介素23(IL-23)、胃蛋白酶原1(PG1)的变化及临床意义。方法分别收集慢性浅表性胃炎、慢性萎缩性胃炎伴肠化生以及胃癌患者病变组织及外周血,免疫组织化学染色检测IL-23在这3种胃部疾病组织中的表达,时间分辨免疫荧光分析法定量检测血清PG1的水平,ELISA检测血清IL-23的水平,Pearson相关分析验证慢性萎缩性胃炎伴肠化生及胃癌患者血清中IL-23与PG1的相关性。结果在组织样本中,与慢性浅表性胃炎组相比,慢性萎缩性胃炎伴肠化生组和胃癌组IL-23表达明显增高。与慢性浅表性胃炎组相比,慢性萎缩性胃炎伴肠化生组和胃癌组血清IL-23浓度也明显升高,且呈递增趋势;而PG1浓度则在慢性萎缩性胃炎伴肠化生组和胃癌组中明显降低。Pearson相关性分析显示慢性萎缩性胃炎伴肠化生组和胃癌组中血清IL-23的水平与PG1呈负相关。结论慢性萎缩性胃炎伴肠化生和胃癌患者组织中IL-23高表达,且血清IL-23的水平与PG1呈负相关。