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目的探讨早期胃癌胃微血管形态变化以及Bcl-2、M2-丙酮酸激酶(M2-PK)的表达特点。方法选取240例因上腹部不适、腹痛、腹胀、反酸等消化不良症状在我院消化外科进行住院治疗的患者,首先行放大胃镜观察胃微血管变化状况,然后根据胃小凹状况分为A、B、C、D、E型。分别检测不同胃小凹分型标本的Bcl-2和M2-PK阳性率。结果浅表性胃炎主要见于A型(65.8%)、B型(59.6%)和C型(22.0%)小凹类型;萎缩性胃炎主要见于C型(38.0%)和D型(50.0%);肠上皮化生主要见于C型(34.0%)、D型(39.3%)和E型(34.7%);不典型增生多见于D型(7.1%)和E型(32.7%);胃癌仅见于E型(16.3%)。不同类型的微血管形态,其Bcl-2及M2-PK阳性率比较,差异有统计学意义(P<0.01)。E型小凹的标本中Bcl-2及M2-PK阳性率(65.3%与67.4%)均显著高于A(7.9%与10.5%)、B(8.5%与10.6%)、C(14.0%与16.0%)、D型(23.2%与26.8%),差异有统计学意义(P<0.01);D型小凹的标本中Bcl-2及M2-PK阳性率均显著高于B型,差异亦有统计学意义(P<0.05)。结论癌前病变及早期胃癌主要发生在D、E型小凹类型;微血管形态可以作为早期胃癌的诊断指标,放大胃镜可以作为早期胃癌诊断的一种临床筛选方法。
Objective To investigate the morphological changes of gastric microvasculature and the expression of Bcl-2 and M2-pyruvate kinase (M2-PK) in early gastric cancer. Methods 240 patients with indigestion due to epigastric discomfort, abdominal pain, bloating, acid reflux and other indigestion symptoms were hospitalized in our hospital. At first, gastroscopy was used to observe the changes of gastric microvasculature, and then divided into A, according to the status of gastric pits. Types B, C, D, and E. The positive rates of Bcl-2 and M2-PK in different subtypes of gastric pit were detected. Results Superficial gastritis was mainly found in type A (65.8%), type B (59.6%) and type C (22.0%) pits. Atrophic gastritis was mainly found in type C (38.0%) and type D (50.0%). Intestinal metaplasia was mainly seen in type C (34.0%), type D (39.3%) and type E (34.7%); dysplasia was more common in type D (7.1%) and type E (32.7%); gastric cancer was only seen in E Type (16.3%). The differences of Bcl-2 and M2-PK positive rates in different types of microvessels were statistically significant (P<0.01). The positive rates of Bcl-2 and M2-PK (65.3% and 67.4%) in E-type foveal specimens were significantly higher than those in A (7.9% vs. 10.5%), B (8.5% vs. 10.6%), and C (14.0% vs. 16.0%), D type (23.2% and 26.8%), the difference was statistically significant (P<0.01); the positive rates of Bcl-2 and M2-PK were significantly higher in D-type foveal specimens than in B type, and the differences were also significant. Statistically significant (P<0.05). Conclusion Precancerous lesions and early gastric cancer mainly occur in type D and E pits. Microvessel morphology can be used as a diagnostic index for early gastric cancer. Magnifying gastroscopy can be used as a clinical screening method for the diagnosis of early gastric cancer.