目的检测慢性浅表性胃炎(CSG)、慢性萎缩性胃炎(CAG)、异型增生(DYS)及胃癌(GC)中端粒酶的活性,并探讨其与胃癌危险因子幽门螺杆菌(Hp)之间的关系.方法采用端粒酶PCR-ELISA法检测24例CSG、48例CAG、13例DYS、36例GC中端粒酶活性.结果 Hp感染率各组无显著差异.端粒酶阳性率GC组中最高(83.33%),其次是DYS组(53.84%)和CAG组(43.75%),CSG组中无一例端粒酶阳性.按肠化(IM)程度,将CAG分成伴IM及不伴IM两组,端粒酶活性在两组有显著差异(57.14% vs 25.00%).在CAG伴IM组,有Hp感染者其端粒酶活性显著高于无Hp感染者(73.68% vs 22.22%).结论胃腺体萎缩及Hp慢性感染两者的共存是细胞永生化的基本条件.

Objective: To investigate the expression of p16, cyclin D1 and Rb protein in gastric carcinoma and premalignant lesions including dysplastic gastric mucosa and intestinal metaplasia gastric mucosa. Methods: Using SP immunohistochemical methods, the expression of p16, cyclin D1 and Rb proteins was detected in 10 specimens of normal gastric mucosa, 15 specimens of dysplastic gastric mucosa, 15 specimens of intestinal metaplasia gastric mucosa, 30 specimens of gastric carcinoma. The clinical characteristics of the 30 patients with gastric carcinoma were analysed to explore the relationship between the parameter detected and biological action of gastric cancer. Results: Expression of p16 protein was detected in 90% of normal gastric mucosa, 86.67% of dysplastic gastric mucosa, 86.67% of intestinal metaplasia gastric mucosa, 36.67% of gastric carcinoma. The positive rate of p16 protein expression in gastric carcinoma is significantly lower than that in normal gastric mucosa and gastric premalignant lesions mucosa (P<0.01). Expression of cyclin D1 protein was detected in 10% of normal gastric mucosa, 20% of dysplastic gastric mucosa, 20% of intestinal metaplasia gastric mucosa, 53.33% of gastric carcinoma. The positive rate of cyclin D1, protein expression in gastric carcinoma is significantly higher than that in normal gastric mucosa and gastric premalignant lesions mucosa (P<0.05). Expression of Rb protein was detected in 90% of normal gastric mucosa, 80% of dysplastic gastric mucosa, 80% of intestinal metaplasia gastric mucosa, 50% of gastric carcinoma. The positive rate of Rb protein expression in gastric carcinoma is significantly lower than that in normal gastric mucosa (P<0.05). The expression of p16, cyclin D1 gene were associated with the degree of differentiation of gastric carcinoma, lymphnodes metastasis and distant metastasis. Conclusion: p16, Cyclin D1 and Rb gene play important role in gastric carcinoma genesis. The expression of p16, cyclin D1 and Rb gene have some value to the diagnosis at earlier stage of gastric cancer. Detection of expression of p16, cyclin D1 gene would be helpful to judge the prognosis of gastric cancer.

患者,男,73岁.因吞咽梗噎,渐进性吞咽困难2月余,于1998年9月来我院就诊,经胃镜检查及病理活检确诊为食管中段鳞癌,分化程度Ⅰ～Ⅱ级,病变距门齿26～33 cm,范围超过7 cm.因患者拒绝手术和放、化疗而于当月在胃镜下行食管扩张,并在食管中段放置10 cm长钛镍网状支架,支架上端距门齿25 cm,术后患者即恢复饮食.1999年2月患者再次出现吞咽困难,胃镜复查发现肿瘤组织生长已超过支架长度,尤以支架远端为甚,致再次狭窄.于是经扩张器扩张及内镜下局部微波治疗后,在食管远端放置了第二支10 cm长支架,支架下端超过贲门口约2 cm,上端距门齿33 cm,与第一支架重叠约2 cm.术后患者食管梗阻症状缓解.1999年4月吞咽困难再次发生,经胃镜检查发现第一次支架上端被肿瘤组织占据而致管腔狭窄,于是经同样方法在食管上端放置了第三支10 cm长支架,该支架上端距门齿22 cm,恰位于食管第一狭窄部位稍下,远端与第一支支架刚好连接,术后患者恢复饮食,但吞咽时有不适感.4个月后随访失去联系.

目的研究p16基因在胃癌组织中的表达及其与胃癌生物学行为的关系.方法采用免疫组化和原位杂交方法检测10例正常胃粘膜、30例胃癌组织中p16基因mRNA和蛋白的表达,并结合其临床资料进行分析.结果 p16基因mRNA和蛋白阳性表达率,在正常胃粘膜均为90%,而胃癌分别为43.33%和36.67%.胃癌组与正常对照组间差异均有显著意义(P＜0.05),p16基因mRNA和蛋白与胃癌分化程度、淋巴结转移与否、远处转移与否呈一定的相关性.结论 p16基因与胃癌发生有关,其表达产物检测可能有助于胃癌预后的判断.

目的:研究肿瘤标志物CA19-9,CA125,CEA对胃癌的诊断价值.方法:用电化学发光法(ECL)检测28例胃癌患者和70例胃良性疾病患者血清CA19-9,CA125,CEA,并对其指标进行比较.结果:胃癌患者CA19-9,CA125,CEA阳性率较高,分别为46.43%,32.14%,39.29%,明显高于胃良性疾病组,且联合检测血清CA19-9,CA125,CEA可以将阳性率提高到89.29%.结论:联合检测血清CA19-9,CA125,CEA对胃癌有较高的诊断价值.

目的:探讨不同年龄组大肠癌患者的特点,提高大肠癌早期诊断率.方法:按年龄分为青年组(≤35岁)、中年组(36～59岁)、老年组(≥60岁),比较不同年龄组大肠癌患者临床表现、内镜表现、病理资料.结果:青年组以腹痛为主占81.08%,中老年组以便血为主占62.32%,各组直肠癌均有较高的比例,青年组右半结肠癌明显多于老年组.结论:本组大肠癌患病高峰为50～70岁,青年组右半结肠癌发生率高,肿瘤恶性程度高;老年组左半结肠癌发生率高,肿瘤恶性程度低,应重视完整大肠检查.

目的评估扩张治疗贲门失弛缓症的疗效及随访治疗后复发率。方法应用气囊扩张治疗并分期随访2年。结果气囊扩张治疗贲门失弛缓症短期疗效（半年内）100％，一年内复发率9％，二年内复发率18％，并有1例恶变。结论气囊扩张是治疗贲门失弛缓症的有效、安全的方法，且复发后可反复行扩张治疗。

近年来收治老年梗阻性黄疸30例,取得较好的治疗效果,现报道如下.

Objective: To investigate the expression of P16 protein in premalignant lesions and gastric carcinoma, including dysplastic gastric mucosa and intestinal metaplasia in gastric mucosa. Methods:The expression of P16 proteins were measured by SP immunohistochemical method in normal gastric mucosa (10 specimens), dysplastic gastric mucosa (15 specimens), intestinal metaplasia in gastric mucosa (15 specimens), gastric carcinomas (30 specimens). Results:The positive expression of P16 protein was 90% in normal gastric mucosa, 86. 67% in dysplastic gastric mucosa, 86.67% in intestinal metaplasia, 36.67% in gastric carcinoma. There were significant differences between gastic carcinoma group and the normal control group or the precancerous group (P 0. 01). Conclusion: P16 protein is associated with the occurrence of gastric carcinoma.

转化生长因子β是一个结构和功能相关的多功能肽家族,由三个同功型组成,人体内转化生长因子β1(TGF-β1)含量最丰富,它是肝细胞增殖、分化、细胞外基质合成的重要递质,近年有关它在肝癌发病中的作用以及对肝癌的诊断价值也受到普遍关注.