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胃癌发生的早期阶段,胃粘膜细胞的形态、免疫学、组织化学和代谢性方面会有异常改变,被认为是癌前病变.在胃粘膜癌前病变研究方面,胃粘膜肠上皮化生、异型增生以及肿瘤相关基因变化是目前研究重点.本文就此领域作一综述.1 胃粘膜肠上皮化生胃粘膜肠上皮化生分为完全型(Ⅰ型)和不完全型(Ⅱ型)肠化生,后者又分为胃型(Ⅱ_a型)和结肠型(Ⅱ_b型)化生.人群肠化生的检出率高达20%,60岁以上增至40%,常出现于胃的各种良性及恶性病变中.Ⅰ型肠化生是在炎症基础上发生,随炎症的加重而加重,它具有炎症反应的性质,与胃癌发生并无直接关系.Ⅱ型肠化生远不如Ⅰ型肠化生多见,常见于缺乏炎症的胃粘膜,它在胃癌旁检出率远高于良性病变.在胃粘膜标本中,可见Ⅱ型肠化生与癌灶混存或移行过渡的状态,特别是Ⅱ_b型肠化生.故认为Ⅱ_b型肠化生与胃癌关系密切.此型肠化生的细胞分化不成熟,细胞异型性较明显,CEA免疫酶标阳性率高.实际上它代表胃粘膜分化异常,回复胚胎早期幼稚化,是种“去分化”表现.许建明
Gastric mucosa intestinal metaplasia metaplasia, abnormality, Gastric mucosa intestinal metaplasia, Gastrointestinal mucosal epithelial metaplasia Proliferation and tumor-related gene changes are the focus of the present study.This article reviews the field.1 gastric mucosa intestinal metaplasia gastric mucosa intestinal metaplasia is divided into complete (type I) and incomplete type (type II) intestinal metaplasia , The latter is divided into stomach type (Ⅱ_a type) and colon type (Ⅱ_b type) metaplasia.The detection rate of intestinal metacercaria people up to 20%, 60 years old to 40%, often appear in the stomach of various benign And malignant lesions.I type intestinal metaplasia is based on the inflammation, with the exacerbation of aggravating aggravating, it has the nature of inflammatory reactions, and gastric cancer is not directly related to type Ⅱ intestinal metaplasia far less than type Ⅰ intestinal metaplasia Students more common, common in the absence of inflammation of the gastric mucosa, it is detected in gastric cancer is much higher than the benign lesions in the gastric mucosa specimens, we can see the type Ⅱ intestinal metaplasia and cancer coexistence or transitional state transition, in particular Ⅱ_b intestinal metaplasia, so that Ⅱ_b intestinal metaplasia and gastric cancer are closely related Immature metaplasia of cell differentiation, cell atypia obvious, CEA enzyme immunoassay positive rate. In fact, it represents the abnormal differentiation of gastric mucosa, naive reply early embryo, is a kind of “de-differentiation” performance. Xu Jianming