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目的:检测C型、D型和E型腺管开口肠上皮化生胃黏膜组织中Ki67、CDX2的表达情况,评估肠上皮化生程度(intestinal metaplasia,IM)与腺管开口形态的相关性.方法:应用免疫组织化学EnVision二步法检测Ki67、CDX2蛋白在452例不同腺管开口胃黏膜病变中的表达情况;苏木素-伊红染色法评估IM的程度.结果:在非萎缩性胃炎胃小凹腺管开口呈B型(B型腺管开口胃炎)、萎缩性胃炎伴IM胃小凹腺管开口呈C型(C型腺管IM)、萎缩性胃炎伴IM胃小凹腺管开口呈D型(D型腺管IM)、萎缩性胃炎伴IM胃小凹腺管开口呈E型(E型腺管IM)、低级别上皮内瘤变和胃窦腺癌组织中Ki67蛋白的表达阳性率分别为16.2%、40.5%、44.0%、64.3%、71.4%和87.1%,E型腺管IM组分别与C、D组之间差别有统计学意义(P=0.002,=0.008),而C与D组差异无统计学意义;以上6组中CDX2蛋白的表达阳性率分别为21.6%、75.0%、78.6%、81.0%、80.4%和84.3%,E型腺管IM组与C、D组之间没有统计学上的差异,但与B型腺管开口胃炎组的差异有统计学意义(P=0.000).IM程度E型>D型>C型,差异有统计学意义(P=0.000).结论:CDX2可能与胃黏膜IM组织的微形态无关;E型腺管IM黏膜比C型、D型的Ki67表达高,IM程度重,胃镜随访检查时应重视这些黏膜改变的活检.
OBJECTIVE: To detect the expressions of Ki67 and CDX2 in intestinal mucosa of intestinal metaplasia of type C, D and E, and to evaluate the correlation between the intestinal metaplasia (IM) and the shape of open duct. Methods: The immunohistochemical EnVision two-step method was used to detect the expression of Ki67 and CDX2 protein in 452 cases of gastric mucosa lesions with different ductal opening. The extent of IM was evaluated by hematoxylin-eosin staining.Results: The concave duct opening was type B (B-type gland opening gastritis), atrophic gastritis with the IM fissure duct opening was C-type (C-type duct IM), atrophic gastritis with the appendix of the gastric fundus opening Type D (D-type duct IM), atrophic gastritis with mucosal opening of the fundus of the anastomosis of the gastric fundus type E (E-type duct IM), positive expression of Ki67 protein in low grade intraepithelial neoplasia and gastric adenocarcinoma tissues The difference was statistically significant (P = 0.002, = 0.008) between the IM group and the C group and the D group in the E group, while the rates were 16.2%, 40.5%, 44.0%, 64.3%, 71.4% and 87.1% The positive rate of CDX2 protein expression in the above 6 groups was 21.6%, 75.0%, 78.6%, 81.0%, 80.4% and 84.3% There was no statistical difference between group C and group D, but there was a significant difference between group B and group B (P = 0.000) .EIM type E> D type> C type, the difference was statistically significant (P = 0.000) .Conclusion: CDX2 may not be related to the micromorphology of IM mucosa in gastric mucosa. The expression of IM67 in E-duct mucosa is higher than that of C-type and D-type, Changed biopsy.