MUC2、MUC5AC、MUC6和P53在胃侵袭前病变与胃癌中的表达及意义

发布时间：2018-12-26 12:05

【摘要】：目的:探讨MUC2、MUC5AC、MUC6和P53在胃侵袭前病变与胃癌中表达的变化及其与早期胃癌临床病理学特征之间的关系,评价常规工作中应用MUC2、MUC5AC、MUC6和P53鉴别胃粘膜活检标本肿瘤性病变与非肿瘤性病变的可行性,从而对胃粘膜活检进行更准确的诊断及治疗提供依据。方法:本研究选取首都医科大学附属北京朝阳医院2012年1月至2017年1月之间的胃标本125例,包括正常胃粘膜活检标本30例、胃粘膜高级别上皮内瘤变ESD切除标本38例和早期胃癌外科根治性切除标本57例。每个病例至少选择1个蜡块,同时切5张切片进行HE染色和MUC2、MUC5AC、MUC6、P53免疫组化染色。MUC2、MUC5AC、MUC6的判读标准:阳性细胞数25%为阴性(-);阳性细胞数25-50%为弱阳性(+);阳性细胞数50-75%为中等阳性(++);阳性细胞数75%为强阳性(+++)。P53的判读标准:阳性细胞数10%为P53(+),反之,则为P53(-)。比较正常胃粘膜、胃粘膜高级别上皮内瘤变和早期胃癌三组中MUC2、MUC5AC、MUC6、P53的表达有无差异,并比较早期胃癌中,MUC2、MUC5AC、MUC6、P53表达在分化程度、浸润深度、Lauren分类、伴粘液产生、间质淋巴组织浸润及淋巴结转移等临床病理学特征中的差异。结果:1.MUC2、MUC5AC、MUC6、P53在正常胃粘膜、胃粘膜高级别上皮内瘤变和早期胃癌中阳性率:MUC2在正常胃粘膜、胃粘膜高级别上皮内瘤变和早期胃癌中阳性率分别为0.0%、22.6%、36.8%;MUC5AC在正常胃粘膜、胃粘膜高级别上皮内瘤变和早期胃癌中阳性率分别为100%、47.4%、54.4%;MUC6在正常胃粘膜、胃粘膜高级别上皮内瘤变与早期胃癌三组中阳性率分别为100%、60.5%、59.6%;正常胃粘膜、胃粘膜高级别上皮内瘤变和早期胃癌中P53阳性率分别为26.7%、68.4%和54.9%。正常胃粘膜、胃粘膜高级别上皮内瘤变和早期胃癌三组病例中MUC2、MUC5AC、MUC6、P53的表达有显著差异(P0.05,P值分别为0.000、0.000、0.000、0.003),MUC2、MUC5AC、MUC6在胃粘膜高级别上皮内瘤变和早期胃癌中的表达均不具有显著性差异。MUC6在胃粘膜高级别上皮内瘤变和早期胃癌中的表达模式发生改变,在38例胃粘膜高级别上皮内瘤变的病例中,MUC6在表层上皮和深部腺体中共同表达者共11例(28.9%),57例早期胃癌病变中,MUC6在癌组织中弥漫表达共12例(21.1%),卡方检验比较P0.05(P=0.379),不具有显著差异。2.MUC2、MUC5AC、MUC6、P53与早期胃癌临床病理特征的关系:肠型胃癌中MUC2阳性者9例,阳性率为24.3%;弥漫型胃癌中MUC2阳性者12例,阳性率为61.9%。MUC2阴性和MUC2阳性两组病例在Lauren分类方面有显著性差异且正相关(P0.01,R=1)。T1a期胃癌中P53阳性者9例,阳性率为36.0%;T1b期胃癌中P53阳性者22例,阳性率为68.8%。P53阴性和P53阳性两组病例在肿瘤浸润深度方面有显著性差异且正相关(P0.01,R=1)。结论:1.MUC2、MUC5AC、MUC6可能作为区分胃肿瘤性病变与非肿瘤性病变的重要辅助诊断手段。2.P53可能作为区分胃侵袭性病变与非侵袭性病变的重要辅助诊断手段。
[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.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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