摘要
目的分析CD133和Survivin在慢性胃炎、肠化生、非典型增生和胃癌组织中表达变化,幽门螺杆菌(Helicobacter pylori, Hp)和胃癌的临床理化因素对其表达的影响。探讨CD133和Survivin在胃癌发展过程中的各个阶段的作用、相互关系及临床意义。
方法一般资料选取天津医科大学总医院门诊胃镜室2010年5月～2010年10月行胃镜检查患者115例,根据病理结果分为慢性炎症组、肠化生组、非典型增生组和胃癌组。其中胃癌患者均为初发病例,术前未经过放化疗或免疫治疗,确诊后经手术治疗并对其术后情况随访。所有入选患者均行13C尿素呼气试验检测Hp,根据结果分Hp阳性组和阴性组。采用免疫组织化学法对CD133和：Survivin的表达变化进行检测,分析比较各组间CD133和Survivin的表达变化与胃癌患者的年龄、性别、分化程度、TNM分期和是否有淋巴结转移等因素的关系及进一步比较CD133和Survivin的相关性。
结果1.各组间年龄和性别的构成差异无统计学意义。2.CD133在慢性胃炎组、肠化生组、非典型增生组和胃癌组中表达的阳性率分别为：6.7%,30.0%,36.7%,77.5%; Survivin在慢性胃炎组、肠化生组、非典型增生组和胃癌组中表达的阳性率分别为：0%,6.7%,33.3%,62.5%,其阳性表达率均呈逐渐递增趋势。3.CD133和Survivin的表达水平在幽门螺杆菌(Hp)阳性组较阴性组的患者中均增高,差异有统计学意义(P<0.05)。4.CD133的表达与胃癌的分化程度、淋巴结转移有关(P<0.05),与年龄、性别和TNM分期无关(P>0.05); Survivin的表达与胃癌的分化程度、TNM分期有关(P<0.05),与年龄、性别和淋巴结转移无关(P>0.05)。5. CD133和Survivin在胃癌中的阳性表达呈正相性(r=0.687,P<0.05)。
结论1.CD133和Survivin在慢性胃炎至胃癌的发展过程中表达上调,提示CD 133、Survivin可能在胃癌的发生、发展中起重要作用。2. CD133在肠化生和非典型增生阶段中出现表达逐渐增加,Survivin在非典型增生中出现表达增加,提示他们可能成为胃癌高危人群监测的分子标志物。3.幽门螺杆菌(Hp)可能为诱发CD133和Survivin表达上调的因素之一。4.CD133的表达与胃癌患者的年龄、性别和TNM分期因素无关；与癌的分化程度和淋巴结转移有关。Survivin的表达与年龄、性别和淋巴结转移无关；与分化程度、TNM分期有关。5.CD133和Survivin的表达呈正相关,提示二者可能通过直接或间接途径促进了相互表达,可能具有协同作用。6.CD133和Survivin有可能通过基因工程技术成为胃癌及癌前病变早期干预和治疗的基因靶点。
Objective To analysis the expression of CD 133 and Survivin in chronic gastritis, intestinal metaplasia, atypical dysplasia and gastric cancer, the effect of Helicobacter pylori and clinical factors. To explore the function, relationship and clinical significance of CD 133 and Survivin.
Methods 115 patients were enrolled in the study from endoscopy room of the General Hospital of Tianjin Medical University Hospital from February 2010 to October 2010. They were divided into groups of chronic gastritis, intestinal metaplasia, atypical dysplasia and gastric cancer according to pathology. Patients were first diagnosed without preoperative chemotherapy or immunotherapy in gastric cancer group, who were treated by surgery after diagnosis and follow-up of their postoperative conditions. Helicobacter pylori was detected by13 C Urea Breath Test in all patients. Acording to the result, they were didvided into positive and negative group. CD 133 and Survivin were detected by immunohistochemical method and further were anlysised these changes and relation with age, sex, degree of differention, TNM stage, lymph node metastasis in gastric cancer and their relevance.
Results 1. The composition of sex and age was no significant difference in different groups.2. The expression rate of CD133+ was 6.7%,30.0%,36.7%,77.5% respectively in chronic gastritis, intestinal metaplasia, dysplasia and gastric carcinoma group; the positive rate of Survivin was 0%,6.7%,33.3%,62.5% respectively. It was shown a tendency of progressive increase.3. The expression level of CD 133 and Survivin were significantly higher in Helicobacter pylori (Hp) positive group than negative group (P＜0.05).4. The expression of CD 133 and Survivin were not correlated with age and gender in gastric cancer patients (P＞0.05). The expression of CD133 was correlated with tumor differentiation, lymph node metastasis (P<0.05) but not with TNM stage (P＞0.05); The expression of Survivin was correlated with differentiation and TNM stage of gastric cancer (P＞0.05), but not with lymph node metastasis (.P>0.05).5. There was a positive correlation between CD 133 and Survivin in gastric cancer (r=0.687).
Conclusions 1. Survivin and CD 133 upregulated in the development of gastric cancer suggested that Survivin and CD133 played an important role in the development of gastric cancer possibly.2. The level of CD133 expression gradually increased in the stage of intestinal metaplasia and atypical dysplasia appeared; The expression of Survivin in atypical dysplasia appeared to increase, which suggested that early intervention for gastric cancer molecular markers.3. Helicobacter pylori (Hp) may be one of the factors which induced upregulation of CD133 and Survivin.4. The expression of CD133 was significantly correlated with differentiation of cancer and lymph node metastasis, but not with age, gender and the TNM stage. The expression of Survivin was significantly associated with differentiation of cancer and TNM stage. 5. The expression of CD133 and Survivin were positively correlated, which suggested they could promote the expression each other through direct or indirect way and had a synergistic effect.6. CD133 and Survivin may become the gene targets for treatment and early intervention of gastric cancer and precancerous lesions through genetic engineering technology.
引文
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