【摘要】：目的:探討MUC2、MUC5AC、MUC6和P53在胃侵襲前病變與胃癌中表達(dá)的變化及其與早期胃癌臨床病理學(xué)特征之間的關(guān)系,評(píng)價(jià)常規(guī)工作中應(yīng)用MUC2、MUC5AC、MUC6和P53鑒別胃粘膜活檢標(biāo)本腫瘤性病變與非腫瘤性病變的可行性,從而對(duì)胃粘膜活檢進(jìn)行更準(zhǔn)確的診斷及治療提供依據(jù)。方法:本研究選取首都醫(yī)科大學(xué)附屬北京朝陽醫(yī)院2012年1月至2017年1月之間的胃標(biāo)本125例,包括正常胃粘膜活檢標(biāo)本30例、胃粘膜高級(jí)別上皮內(nèi)瘤變ESD切除標(biāo)本38例和早期胃癌外科根治性切除標(biāo)本57例。每個(gè)病例至少選擇1個(gè)蠟塊,同時(shí)切5張切片進(jìn)行HE染色和MUC2、MUC5AC、MUC6、P53免疫組化染色。MUC2、MUC5AC、MUC6的判讀標(biāo)準(zhǔn):陽性細(xì)胞數(shù)25%為陰性(-);陽性細(xì)胞數(shù)25-50%為弱陽性(+);陽性細(xì)胞數(shù)50-75%為中等陽性(++);陽性細(xì)胞數(shù)75%為強(qiáng)陽性(+++)。P53的判讀標(biāo)準(zhǔn):陽性細(xì)胞數(shù)10%為P53(+),反之,則為P53(-)。比較正常胃粘膜、胃粘膜高級(jí)別上皮內(nèi)瘤變和早期胃癌三組中MUC2、MUC5AC、MUC6、P53的表達(dá)有無差異,并比較早期胃癌中,MUC2、MUC5AC、MUC6、P53表達(dá)在分化程度、浸潤(rùn)深度、Lauren分類、伴粘液產(chǎn)生、間質(zhì)淋巴組織浸潤(rùn)及淋巴結(jié)轉(zhuǎn)移等臨床病理學(xué)特征中的差異。結(jié)果:1.MUC2、MUC5AC、MUC6、P53在正常胃粘膜、胃粘膜高級(jí)別上皮內(nèi)瘤變和早期胃癌中陽性率:MUC2在正常胃粘膜、胃粘膜高級(jí)別上皮內(nèi)瘤變和早期胃癌中陽性率分別為0.0%、22.6%、36.8%;MUC5AC在正常胃粘膜、胃粘膜高級(jí)別上皮內(nèi)瘤變和早期胃癌中陽性率分別為100%、47.4%、54.4%;MUC6在正常胃粘膜、胃粘膜高級(jí)別上皮內(nèi)瘤變與早期胃癌三組中陽性率分別為100%、60.5%、59.6%;正常胃粘膜、胃粘膜高級(jí)別上皮內(nèi)瘤變和早期胃癌中P53陽性率分別為26.7%、68.4%和54.9%。正常胃粘膜、胃粘膜高級(jí)別上皮內(nèi)瘤變和早期胃癌三組病例中MUC2、MUC5AC、MUC6、P53的表達(dá)有顯著差異(P0.05,P值分別為0.000、0.000、0.000、0.003),MUC2、MUC5AC、MUC6在胃粘膜高級(jí)別上皮內(nèi)瘤變和早期胃癌中的表達(dá)均不具有顯著性差異。MUC6在胃粘膜高級(jí)別上皮內(nèi)瘤變和早期胃癌中的表達(dá)模式發(fā)生改變,在38例胃粘膜高級(jí)別上皮內(nèi)瘤變的病例中,MUC6在表層上皮和深部腺體中共同表達(dá)者共11例(28.9%),57例早期胃癌病變中,MUC6在癌組織中彌漫表達(dá)共12例(21.1%),卡方檢驗(yàn)比較P0.05(P=0.379),不具有顯著差異。2.MUC2、MUC5AC、MUC6、P53與早期胃癌臨床病理特征的關(guān)系:腸型胃癌中MUC2陽性者9例,陽性率為24.3%;彌漫型胃癌中MUC2陽性者12例,陽性率為61.9%。MUC2陰性和MUC2陽性兩組病例在Lauren分類方面有顯著性差異且正相關(guān)(P0.01,R=1)。T1a期胃癌中P53陽性者9例,陽性率為36.0%;T1b期胃癌中P53陽性者22例,陽性率為68.8%。P53陰性和P53陽性兩組病例在腫瘤浸潤(rùn)深度方面有顯著性差異且正相關(guān)(P0.01,R=1)。結(jié)論:1.MUC2、MUC5AC、MUC6可能作為區(qū)分胃腫瘤性病變與非腫瘤性病變的重要輔助診斷手段。2.P53可能作為區(qū)分胃侵襲性病變與非侵襲性病變的重要輔助診斷手段。
[Abstract]:Objective: to investigate the relationship between the expression of MUC2,MUC5AC,MUC6 and p53 in gastric preinvasive lesions and gastric cancer and the clinicopathological features of early gastric cancer, and to evaluate the application of MUC2,MUC5AC, in routine work. The feasibility of MUC6 and p53 in differentiating gastric mucosal biopsy specimens from non-neoplastic lesions is feasible, so as to provide evidence for more accurate diagnosis and treatment of gastric mucosal biopsies. Methods: 125 gastric specimens were collected from Beijing Chaoyang Hospital affiliated to Capital Medical University from January 2012 to January 2017, including 30 specimens of normal gastric mucosa. 38 cases of high grade intraepithelial neoplasia of gastric mucosa were resected by ESD and 57 cases of early gastric carcinoma underwent surgical radical resection. At least one wax block was selected for each case, and 5 sections were cut simultaneously for HE staining and MUC2,MUC5AC,MUC6,P53 immunohistochemical staining. The standard of MUC2,MUC5AC,MUC6 interpretation: the number of positive cells was negative in 25% (-); Positive cells 25-50% weak (); positive cells 50-75% medium positive (); 75% of the positive cells were strongly positive (). P53; 10% of the positive cells were p53 (),; conversely, p53 (-). The expression of MUC2,MUC5AC,MUC6,P53 in normal gastric mucosa, high grade intraepithelial neoplasia of gastric mucosa and early gastric cancer was compared, and the expression of MUC2,MUC5AC,MUC6,P53 in early gastric cancer was compared in differentiation degree, depth of infiltration and Lauren classification. Differences in clinicopathological features with mucus production, interstitial lymphoid infiltration and lymph node metastasis. Results: 1. The positive rate of MUC5ACmMUC6 p53 in normal gastric mucosa, high grade intraepithelial neoplasia of gastric mucosa and early gastric cancer: the positive rate of MUC2 in normal gastric mucosa, high grade intraepithelial neoplasia of gastric mucosa and early gastric cancer was 0. 0%, respectively. 22.6 and 36.8; The positive rates of MUC5AC in normal gastric mucosa, high grade intraepithelial neoplasia of gastric mucosa and early gastric cancer were 47.4% and 54.4%, respectively. The positive rates of MUC6 in normal gastric mucosa, high grade intraepithelial neoplasia of gastric mucosa and early gastric cancer were 100%, 60.5% and 59.6%, respectively. The positive rates of p53 in normal gastric mucosa, high grade intraepithelial neoplasia of gastric mucosa and early gastric cancer were 26.7% and 54.9%, respectively. The expression of MUC2,MUC5AC,MUC6,P53 in normal gastric mucosa, gastric mucosa with high grade intraepithelial neoplasia and early gastric cancer was significantly different (P = 0.0000.0000.0000.000,0.003, respectively). The expression of MUC2,MUC5AC, was higher than that of normal gastric mucosa (P < 0.05). There was no significant difference in the expression of MUC6 between high grade intraepithelial neoplasia of gastric mucosa and early gastric carcinoma. The expression pattern of MUC6 in gastric mucosal high grade intraepithelial neoplasia and early gastric cancer was changed. In 38 cases of high grade intraepithelial neoplasia of gastric mucosa, 11 cases (28.9%) were co-expressed MUC6 in surface epithelium and deep gland, 12 cases (21.1%) were diffusely expressed MUC6 in cancer tissue of 57 cases of early gastric cancer. There was no significant difference between Chi-square test (P0. 379). 2. The relationship between MUC2, MUC5ACMUC6, p53 and clinicopathological features of early gastric cancer: 9 cases of intestinal type gastric carcinoma were positive for MUC2, the positive rate was 24.3%; There were 12 cases of MUC2 positive in diffuse gastric carcinoma, the positive rate was 61.9%.MUC2 negative and MUC2 positive, and there was a significant difference in Lauren classification between the two groups (P 0.01). 9 cases of T1a gastric cancer were positive for p53. The positive rate was 36.0; There were 22 cases of positive p53 in T1b gastric carcinoma. The positive rate was 68.8%.P53 negative and p53 positive. There was significant difference in the depth of tumor invasion between the two groups (P 0.01). Conclusion: 1. MUC5ACMUC6 may be an important auxiliary diagnostic method for differentiating gastric neoplastic lesions from non-neoplastic lesions, and 2.P53 may be an important auxiliary diagnostic method for differentiating invasive and non-invasive gastric lesions. 2.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.2

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