摘要
目的:通过观察p53、PCNA、CerbB-2的表达及细胞核DNA含量在慢性萎缩性胃炎伴异型增生的中医各证型中的变化,探讨各证型之间在病理组织学及分子生物学水平上有无一定的差异,探索中医辨证分型的客观指标,以期更好地协助指导中医药防治慢性萎缩性胃炎伴异型增生。
材料与方法:选取146例慢性萎缩性胃炎伴异型增生患者进行中医辨证分型;采用Feulgen染色、病理图像定量分析细胞核DNA含量和免疫组织化学S-P法检测此146例患者胃粘膜组织中p53、PCNA、CerbB-2的表达情况。
结果:
1.慢性萎缩性胃炎伴轻度异型增生即有癌基因的阳性表达,而且轻、中、重度异型增生之间的p53、PCNA阳性表达均无显著性差异(P均>0.05),CerbB-2在轻、重度之间存在非常显著性差异(P<0.01)。
2.DNA含量随异型增生程度的加重逐渐增加,且轻、中、重度异型增生之间存在非常显著性差异(P<0.01).
3.p53、CerbB-2阳性表达率在慢性萎缩性胃炎伴异型增生中医各证型间呈显著性差异(P<0.05),且阳性表达率均存在胃络瘀血型>胃阴不足型>脾胃虚弱型>脾胃湿热型>肝胃不和型的递进关系。
4.PCNA阳性表达率在各证型间无显著性差异(P>0.05)。
5.DNA含量在各证型间存在非常显著性差异(P=0.01),且胃络瘀血型>胃阴不足型>脾胃虚弱型>脾胃湿热型>肝胃不和型。
结论:
1.慢性萎缩性胃炎伴异型增生的中医辨证分型有其一定的病理组织学及分子生物学基础。
2.轻、中、重度异型增生均有癌变的可能,且随着异型增生程度的加重癌变的可能性
Purpose: Through observing the variety of the expression of p53、 PCNA、 CerbB-2 and thenuclear DNA content in the syndromes of Traditional Chinese Medicine(TCM) of chronicatrophic gastritis with dysplasia, to study the difference of the syndromes of TCM in thepathologic histology and molecule biology level. Exploring objective and quantitative indexesof syndromes of TCM may be as a guidance to TCM in preventing and treating the chronicatrophic gastritis with dysplasia.Subjects and Methods: 146 cases with chronic atrophic gastritis with dysplasia were dividedinto five types according to the Syndrome Differentiation of TCM. The nuclear DNA contentwas quantatively determined by Feulgen dying method and image analysis technique.Meanwhile S-P immunohistochemical method was applied to detected the expression of p53、PCNA、 CerbB-2 in stomach mucosa.Results:1. There ever was the positive expression of oncogenes in the chronic atrophic gastritis withmild dysplasia, but no significant difference was found in the expression of p53 and PCNAamong mild, moderate or severe dysplasia(P>0.05).While the expression of CerbB-2 betweenmild and severe dysplasia had very significant difference(P<0.01).2.The nuclear DNA content increased with the increment of the severity of dysplasia in gastricmucosa, and there was very significant difference in every type of dysplasia(P<0.01).3.The positive expression of p53 and CerbB-2 among all these syndromes of TCM hadsignificant difference (P<0.01), and they both had a significant stepwise crescendo tendencyin the following sequence, Disharmony between the Liver and Stomach, Damp Heat in theSpleen and Stomach, Deficiency of the Spleen and Stomach, Deficiency of Stomach Yin,Blood Stagnation of the Stomach.4.The positive expression of PCNA had not significant difference in every syndrome of TCM
(p>0.05).5. Significant difference of the nuclear DNA content was found in all these syndromes ofTCM, and the regular sequence was Disharmony between the Liver and Stomach, Damp Heatin the Spleen and Stomach, Deficiency of the Spleen and Stomach, Deficiency of StomachYin, Blood Stagnation of the Stomach.Conclusions:l.The syndromes of TCM of chronic atrophic gastritis with dysplasia were on the basis ofpathologic histology and molecule biology reliably, and it might play partly a good guidancein treating this disease.2.Mild, moderate and severe dysplasia all had the possibility of carcinogenesis, and thepossibility increased with the increment of the severity of dysplasia in gastric mucosa.3. The worse of the syndromes of TCM of chronic atrophic gastritis with dysplasia increased by degrees, and the regular sequence was Disharmony between the Liver and Stomach, Damp Heat in the Spleen and Stomach, Deficiency of the Spleen and Stomach, Deficiency of Stomach Yin, Blood Stagnation of the Stomach.4. It had been approved that p53% CerbB-2 and the nuclear DNA content could be used as some important indexes for diagnosis and classification of chronic atrophic gastritis with dysplasia, and for guidance of treatment.5. The sensitivity of PCNA was higher, while its particularity was inadequate. It was unsuitable to be as the classification index, but it was helpful to diagnosis.
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