TRAIL在食道鳞癌及癌旁组织中的表达

目的　研究人肿瘤坏死因子相关凋亡诱导配体 (TNF relatedapoptosisinducingligand ,TRAIL)在食道鳞癌及癌旁组织中的表达及意义。方法　采用免疫组化S -P法 ,检测 42例食道鳞状细胞癌及其癌旁组织中TRAIL蛋白表达水平。结果　TRAIL在正常食道粘膜上皮、单纯增生、不典型增生、鳞癌组织中其阳性表达呈递减趋势 (P <0 .0 1) ;在Ⅰ、Ⅱ级鳞癌明显高于Ⅲ级和未分化鳞癌 (P <0 .0 1)。而在早期鳞癌和晚期鳞癌中的表达无差异 (P >0 .0 5 )。伴有淋巴结转移组和无转移组之间无差异 (P >0 .0 5 )。结论　TRAIL的表达可能与食道鳞癌的发生、发展密切相关 ;与食道鳞癌的分级呈负相关 ;与癌组织浸润深度和淋巴结转移无关。     

食管内外气体造影CT的临床实验研究

食管癌的最佳治疗计划需要确定诊断的准确资料，食管内外气体造影电子计算机Ｘ线断层摄影（ＣＴＩＥＩＥ）可同时显示食管粘膜病变及食管肿瘤外侵与周围组织器官的直接征象，故提供的临床资料明显优于Ｘ线、ＣＴ平扫及有关检查。ＣＴＩＥＩＥ动物实验及临床研究证实无生理、病理性损害，未出现任何并发症。作者认为，该方法操作简便安全，在食管癌的诊治和评价预后方面具有一定的实用价值。     

Ⅰ型胶原蛋白基因在反流性食管炎、Barrett食管及食管腺癌中的表达

目的探讨反流性食管炎、Barrett食管及食管腺癌黏膜组织中Ⅰ型胶原蛋白(COL1A1)基因mRNA的表达水平及意义。方法经胃镜取材,采用荧光定量PCR方法检测反流性食管炎、Barrett食管、食管腺癌组织中COL1A1基因mRNA的表达水平。结果 COL1A1mRNA在正常组和反流性食管炎阴性组食管黏膜中呈低表达(0.154±0.119,0.152±0.105),在Barrett食管与食管腺癌食管黏膜中呈明显的高表达(0.396±0.170,0.726±0.561)。并且在从正常→反流性食管炎→Barrett食管→食管腺癌的发生、发展过程中,COL1A1mRNA的表达呈现渐进性增强,并与病期有关。结论 COL1A1基因的异常表达与反流性食管炎、Barrett食管和食管腺癌的发生、发展密切相关;COL1A1mRNA的表达水平可用作监测Barrett食管和食管腺癌早期发生及干预治疗效果的有用指标。     

萘丁美酮在混合反流模型干预治疗中的作用

目的探讨萘丁美酮在混合反流模型干预治疗中的作用。方法健康SD大鼠100只,随机分为反流模型组(Y组,46只)、萘丁美酮组(R组,46只)和正常对照组(C组,8只)。分别观察Y组、R组术后5、17、28、40周及C组40周时食管黏膜的病理改变,检测环氧合酶-2(COX-2)、增殖细胞核抗原(PCNA)、细胞周期蛋白D1(CD1)的表达情况。结果①R组不同时段的损伤积分和Barrett食管(BE)的发生率均低于Y组。②Y组COX-2、PCNA及CD1从正常→反流性食管炎(RE)→BE→食管腺癌(EAC)的阳性表达率和表达程度逐渐增强。③R组不同时段COX-2、PCNA、CD1的表达均低于Y组,且COX-2表达程度和阳性表达率与Y组相比均有统计学意义(P<0.05);R组40周PCNA的表达程度及阳性表达率与Y组相比有统计学差异(P<0.05)。结论COX-2、PCNA和CD1基因的高表达参与了从RE→BE→EAC的发展过程,是BE、EAC发生、发展的早期分子事件。萘丁美酮可影响COX-2、PCNA和CD1的表达,减轻炎症的程度并减缓病程的进展,降低BE和重度不典型增生的发生率,抑制腺癌的发生。     

大鼠混合反流模型中COX-2、PCNA、Cyclin D_1的表达

目的探讨环氧合酶-2(COX-2)、增殖细胞核抗原(PCNA)及细胞周期蛋白D1(Cyclin D1)这3项指标在反流性食管炎的发生、发展及癌变过程中的变化情况。方法健康SD大鼠54只,随机分为2组:反流模型组46只,正常对照组8只。分别观察反流模型组术后5、17、28、40周,正常对照组40周时食管黏膜的病理变化,检测COX-2、PCNA、Cyclin D1的表达情况。结果在反流性食管炎的发展过程中,COX-2、PCNA、Cyclin D1从正常→反流性食管炎(RE)→Barrett食管(BE)→食管腺癌(EAC)的阳性表达率分别为0.0%、42.1%、73.7%、100.0%;0.0%、42.1%、63.2%、100.0%;12.5%、42.1%、63.2%、100.0%。COX-2、PCNA、Cyclin D1的表达程度逐渐增强。RE、BE、EAC的表达明显高于正常对照(P<0.05),RE与BE、EAC间有显著性差异(P<0.05),BE和EAC间无统计学差异可能是EAC的例数较少。结论在混合反流造成黏膜损伤形成RE的同时,COX-2、PCNA和Cyclin D1的表达增强,并随病程的发展逐渐增强。说明COX-2、PCNA和Cyclin D1基因的高表达参与了从RE→BE→EAC的发展过程,是BE、EAC发生、发展的早期分子事件。     

胆汁反流与食管黏膜上皮损伤的研究进展

尽管十二指肠胃食管反流的研究已有100多年历史,但不明点仍很多。本文复习文献并结合我们的研究成果,就胆汁对食管黏膜的损伤,包括损伤的可能机制、食管内胆汁反流的诊断、治疗等方面作以介绍,重点对胆汁在Barrett食管和食管腺癌发生中的作用及其防治作了阐述。     

Ablation of Barrett's esophagus using the second-generation argon plasma coagulation

Objective To investigate the efficacy and safety of the second-generation argon plasma coagulation (VIO APC) in ablation of Barrett's esophagus. Methods Eighteen patients with Barrett's esophagus (12 males, median age of 55 years, median length of 2.1 cm,1 low-grade dysplasia, 13 cases of short segment Barrett's esophagus) received VIO APC, which was performed at a power setting of 40W and argon gas flow at 1. 5-2. 0 L/min, "forced" mode, in 1-3 sessions (mean 1.3). All the patients received treatment with high-dose proton pump inhibitors. The main complaints before ablation were upper abdominal pain in 12 patients (66%), sour regurgitation in 14 patients (77%), and dysphagia or odynophagia in 7 patients (38%). Two patients (11%) had esophageal hiatal hernia. Results The percentage of patients in whom ablation was endoscopically achieved proximal to the gastroesophageal junction was 77. 8%(14/18), and histologically achieved in 66. 7% (12/18). Berried glands were observed in 2 patients who had achieved endoscopic ablation, the areas of Barrett's mucosa were reduced by more than 60% in the other 4 patients. After treatment, 4 patients had transient retrosternal pain and 3 patients had mild epigastric discomfort. One patient had small amounts of hemorrhage during the process, and it ceased after norepinephrine and thrombosin were administered through endoscope biopsy channel. No esophageal stricture or other severe adverse events was observed. During 11.8 (4-15) months' follow-up, the patients who had achieved the complete ablation had no evidence of relapse of Barrett's esophagus. Conclusion VIO APC with a relatively low power setting can effectively ablate the Barrett's mucosa with special intestinal metaplasia when standard APC has been done. No severe adverse events were observed. Long-term follow-up is needed to assess cancer prevention and the durability of the neo-squamous epithelium.     

大鼠Barrett食管癌变相关基因的初步筛选

目的初步筛选大鼠Barrett食管(Barrettsesophagus,BE)癌变相关基因。方法建立胃十二指肠食管反流SD大鼠动物模型,用含有4096条双点大鼠cDNA芯片分别比较BE、食管腺癌(esophagealadenocarcinoma,EA)与正常食管上皮(normalcontrol,NC)mRNA差异表达情况。结果芯片杂交差异表达在3倍以上的基因:EA和NC杂交芯片377项,其中上调表达90条,下调表达142条;BE和NC杂交芯片448项,其中上调表达312条,下调表达136条。相对于BE,EA表达上调的基因112条,下调156条。与肿瘤发生相关的已知基因24条,上调18条,下调6条。结论与BE比较,EA基因表达谱发生了明显改变,与肿瘤发生相关的基因改变明显,差异表达的基因可能与肿瘤的发生相关。