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目的：观察细胞凋亡和增殖及其调控基因在胃癌及癌前病变发生发展过程中的异常变化 ,探讨细胞凋亡在胃癌演变中的作用。方法：对 128例胃癌及癌前病变患者和正常人 ,采用原位末端标记法 (terminal deoxynucleotidly transferase mediated labelling， TUNEL)及免疫组化技术检测胃粘膜上皮细胞凋亡、增殖及 bcl- 2/bax表达。结果：正常人、浅表性胃炎、萎缩性胃炎、肠上皮化生、不典型增生、胃癌的细胞凋亡指数分别依次为 (4.58± 1.92)％、 (10.14± 2.56)％、 (24.6± 35.19)％、 (26.26± 9.34)％、 (19.35± 4.04)％、 (19.81± 4.66)％ ;PCNA指数分别为 (3.93± 1.02)％、 (13.58± 4.65)％、 (20.16± 4.89)％、 (24.30± 4.44)％、 (39.79± 6.37)％、 (54.79± 10.6)％ ; bcl- 2蛋白表达分别为： 0％、 18.6％、 20％、 38.5％、 44.4％、 58.3％ ;bax蛋白表达分别为 20％、 51.2％、 55％、 30.85％、 27.8％、 16.7％。结论：胃粘膜癌变过程中 ,起初三个阶段细胞凋亡和 PCNA同时增加 ,而至肠化生后 ,细胞凋亡指数显著减少， PCNA指数显著增加 ;凋亡调控基因 bcl- 2和 bax的比值逐渐增加 ,尤其肠化生阶段后增加显著 ,说明在胃癌演变过程中它们起重要作用 ,临床防治胃癌发生应从肠化生之前着手。
OBJECTIVE: To observe the abnormal changes in apoptosis and proliferation and its regulatory genes in the development of gastric cancer and precancerous lesions, and to explore the role of apoptosis in the evolution of gastric cancer. METHODS: Apoptosis, proliferation, and bcl-2/bax in gastric epithelial cells were detected in 128 patients with gastric cancer and precancerous lesions and normal controls by terminal deoxynucleotidyl transfer mediated labelling (TUNEL) and immunohistochemistry. expression. Results: The apoptotic index of normal people, superficial gastritis, atrophic gastritis, intestinal metaplasia, atypical hyperplasia, and gastric cancer were (4.58± 1.92)%, (10.14± 2.56)%, (24.6± 35.19) respectively. )%, (26.26 ± 9.34)%, (19.35 ± 4.04)%, (19.81 ± 4.66)%; PCNA index was (3.93 ± 1.02)%, (13.58 ± 4.65)%, (20.16 ± 4.89)%, ( 24.30 ± 4.44)%, (39.79 ± 6.37)%, (54.79 ± 10.6)%; bcl-2 protein expression was: 0%, 18.6%, 20%, 38.5%, 44.4%, 58.3%; bax protein expression It is 20%, 51.2%, 55%, 30.85%, 27.8%, 16.7%. CONCLUSIONS: During gastric carcinogenesis, both cell apoptosis and PCNA increased at the initial three stages, and after the intestinal metaplasia, the apoptotic index decreased significantly and the PCNA index increased significantly; the ratio of the apoptosis-regulating gene bcl-2 to bax Gradually increased, especially after the stage of intestinal metaplasia increased significantly, indicating that they play an important role in the evolution of gastric cancer, clinical prevention and treatment of gastric cancer should start before the metaplasia.