目的 分析早期胃癌、高级别上皮内瘤变和慢性非萎缩性胃炎组织的mRNA和miRNA表达谱特征,为了解胃癌的发生机制提供线索.方法 运用mRNA和miRNA表达谱芯片技术对19例早期胃癌、18例高级别上皮内瘤变和11例慢性非萎缩性胃炎组织进行分析,寻找差异基因,并通过GO富集分析了解其生物学功能.通过整合分析miRNA及mRNA表达谱芯片数据,构建与胃癌发生相关的miRNA-mRNA表达调控网络.结果 高级别上皮内瘤变与早期胃癌组织mRNA表达谱特征较相似,均与慢性非萎缩性胃炎组存在显著差异.在高级别上皮内瘤变和早期胃癌患者组织中表达上调的基因主要参与炎症、免疫反应.早期胃癌组与慢性非萎缩性胃炎组miRNA表达谱差异显著,与慢性非萎缩性胃炎相比,有24个miRNA在早期胃癌中低表达,其调控的668个mRNA在早期胃癌中高表达,这些mRNA主要生物学功能集中在与炎症、免疫反应及与癌症相关的信号通路上.结论 胃癌变早期已出现基因表达谱改变,免疫、炎症反应是胃癌发生的早期事件,在这一过程中miRNA的表达调控可能起了重要作用.

目的 探讨累及消化系统的白塞病的临床特征,提高临床医师对该病的认识.方法 回顾性分析首都医科大学附属北京世纪坛医院2008年5月至2020年7月收治的以消化系统为主要表现的白塞病患者42例.结果 42例白塞病患者中,男25例,女17例,年龄(40.4±15.9)岁(17～84岁),中位病程(9.8±8.0)年,90.5％的消化系统症状发生在其他症状之后,主要症状为腹痛、腹胀(78.6％),其次为腹泻、吞咽疼痛、消化道出血等.内镜下表现以溃疡为主,部位以回肠末段、回盲部、升结肠最常见.5例布加综合征中2例下腔静脉血栓,3例下腔静脉合并肝静脉血栓.32例行组织病理学检查,8例提示血管炎.采用糖皮质激素联合免疫抑制剂及抗肿瘤坏死因子-α 拮抗剂治疗,85.7％的患者症状好转,3例行手术治疗,手术原因:合并穿孔2例,合并肠梗阻1例.结论 白塞病患者以青壮年发病为主,消化系统表现多样,以腹痛腹胀为主,部分患者可出现严重并发症,内镜下表现有一定特点,有消化道症状者应积极完善内镜检查,少部分患者可出现布加综合征,在临床工作中应加强对白塞病的认识.

目的 分析原发性胃淋巴瘤(primary gastric lymphoma,PGL)及内镜下疑诊PGL患者的临床病理和内镜特征,提高PGL的诊断准确率.方法 选取2010年12月至2018年12月在首都医科大学附属北京世纪坛医院消化内科明确诊断为PGL患者43例(病理确诊组)、病理否定PGL患者75例(病理否定组,病理诊断阴性15例、胃癌60例),回顾性分析其内镜及临床病理特征.结果 腹痛是PGL、疑似PGL患者典型症状,分别占41.9％和32.0％,两组之间性别、年龄、临床症状差异无统计学意义(P＞0.05).病理确诊组内镜下表现:53.5％溃疡性病变,34.9％隆起性病变,11.6％浸润性生长病变.病理否定组内镜下表现:28.0％浸润性生长病变,37.3％溃疡性病变,34.7％隆起性病变,两组患者的内镜表现比较,差异有统计学意义(P＜0.05).病理类型以弥漫大B细胞淋巴瘤居多.结论 PGL和疑诊PGL患者具有相似的临床症状,内镜表现均以溃疡性病变为主,虽然PGL的诊断率相对较低,但可以通过内窥镜进行鉴别.为了提高诊断准确率,应进行重复的内窥镜活检,并在未来开发新的内镜技术.

目的 探讨T1M1期胃癌患者的临床病理特征及预后影响因素.方法 筛选SEER数据库T1M1期胃癌患者,应用Kaplan-Meier法进行单因素生存分析及生存曲线绘制,采用Cox比例风险回归模型分析影响肿瘤特异性生存的独立因素.结果 共纳入符合要求T1M1期胃癌患者1144例,纳入生存分析患者972例,中位生存时间(5.000±0.312)个月,胃癌特异性1年生存率26.1％.单因素分析结果显示,年龄、性别、肿瘤分化程度、是否合并淋巴结转移、远处转移部位与T1M1期胃癌患者肿瘤特异性生存密切相关,Cox多因素分析结果显示,高龄、肿瘤分化程度差、无淋巴结转移、合并多器官转移的T1M1期胃癌患者生存期更短.结论 T1M1期胃癌患者预后差,中位生存时间不足半年,高龄、肿瘤分化程度差、无淋巴结转移、合并多器官转移是影响T1M1期胃癌患者预后的独立危险因素.

Background MicroRNAs (miRNAs) are attracting substantial interest as promising noninvasive biomarkers for gastric cancer (GC). Our study aimed to identify circulating miRNAs that are potential noninvasive markers for precancerous lesions and early gastric cancers (EGCs). Material/Methods Plasma specimens were obtained from 58 gastritis subjects, 54 patients with precancerous lesions, and 38 EGC patients for study. Results Significant differences in the plasma expression levels of miR-19a-3p, miR-22-3p, miR-146a-5p, and miR-483-5p (all P<0.05) were observed between EGC patients and gastritis subjects. Multivariable analysis showed that age (OR, 1.054; 95% CI, 1.006–1.104), miR-19a-3p expression (OR, 3.676; 95% CI, 1.914–7.061), and miR-483-5p expression (OR, 1.589; 95% CI, 1.242–2.033) were independently associated with EGCs and precancerous lesions. A combined diagnostic model incorporating these 3 variables for the prediction of EGCs and precancerous lesions was derived. The area under the receiver operating characteristic curve (AUC) of the model was 0.84; the sensitivity was 87.7% and the specificity was 62.8% at the cutoff value of −0.08. Conclusions Plasma miR-19a-3p and miR-483-5p are promising and powerful noninvasive markers for the early detection of GC. Patients are more willing to undergo noninvasive diagnostic procedures than gastroscopy for cancer screening, economizing limited medical resources.

通过实时荧光定量聚合酶链反应(PCR)测定不同阶段胃癌、胃癌前病变患者组织标本和胃癌细胞株中长链非编码RNA尿路上皮癌抗原1(UCA1)的表达水平，并通过体外功能实验观察UCA1对胃癌细胞的作用及其机制。结果发现与慢性非萎缩性胃炎患者组织标本和正常胃黏膜上皮细胞株相比，UCA1在各阶段胃癌、胃癌前病变患者的组织标本和胃癌细胞株中的表达水平均升高。UCA1可能通过影响细胞膜功能、膜表面糖蛋白合成、细胞信号转导等生物学过程促进胃癌细胞的增殖、迁移。

Background: Long non-coding RNAs (LncRNAs) could potentially function as diagnostic markers for gastric carcinoma. Nevertheless, the expression profile and biological feature of LncRNAs in early gastric cancer (EGC) remains to be explored. Material/Methods: LncRNA expression microarray analysis was performed on 6 paired EGC tissues. One deregulated LncRNA, LOC389332, was validated using a quantitative reverse-transcription polymerase chain reaction (qRT-PCR) assay using independent tissue samples and cell lines. The Cell Counting Kit-8 (CCK-8) assay and wound healing assay were conducted to evaluate its influences on the proliferation and migration of gastric cancer cells. LncRNA expression microarray and gene ontology (GO) analysis were also performed on the LOC389332 knockdown cell line model to explore the molecular feature of LOC389332 in gastric carcinoma. Results: The LncRNA expression profiling showed that 72 LncRNAs were significantly differentially expressed in EGC tissues. The results in the validation phase revealed that LOC389332 was remarkably overexpressed in gastric carcinoma tissues, precancerous lesions, and gastric cancer cells. Functional study showed that knockdown of LOC389332 expression could inhibit cell proliferation and migration. LncRNA expression microarray on the LOC389332 knockdown cell line model revealed that 393 mRNAs were differentially expressed. The GO enrichment analysis indicated that the downregulated genes were mainly associated with cell membrane function, signal transmission process, and cell adhesion process. Conclusions: The LncRNA expression profile between EGC and gastritis tissues was significantly different. LOC389332 was potential non-coding oncogenes in gastric cancer, and it may perform its function through altering cell membrane function, signal transmission, and cell adhesion.

Many basic properties of the T-cell receptor (TCR) repertoire require clarification, and the changes occurring in the TCR repertoire during carcinogenesis, especially during precancerous stages, remain unclear. This study used deep sequencing analyses to examine 41 gastric tissue samples at different pathological stages, including low-grade intraepithelial neoplasia, high-grade intraepithelial neoplasia, early gastric cancer and matched adjacent tissues, to define the characteristics of the infiltrating TCRβ repertoire during gastric carcinogenesis. Moreover, to illustrate the relationship between the local molecular phenotype and TCR repertoire of the microenvironment, whole-genome gene expression microarray analysis of the corresponding gastric precancerous lesions and early gastric cancer tissues was conducted. Our results showed that the degree of variation in the TCR repertoire gradually increased during tumourigenesis. Integrative analysis of microarray data and the TCR repertoire variation index using the network-based Clique Percolation Method identified an 11-gene module related to the inflammatory response that can predict the overall survival of gastric cancer (GC) patients. In conclusion, our results revealed the multistage heterogeneity of tissue-infiltrating TCR repertoire during carcinogenesis. We report a novel way for identifying prognostic biomarkers for GC patients and improves our understanding of immune responses during gastric carcinogenesis.

Objective To investigate the histologic diagnostic reliability of endoscopic forceps biopsy( EFB) and endoscopic resection( ER) for gastric intraepithelial neoplasia( GIEN) . Methods A total of 98 patients diagnosed as gastric intraepithelial neoplasia by endoscopic biopsy in Peking Union Medical College Hospital from January 2010 to March 2015 were analyzed retrospectively, including 20 cases of low?grade gastric intraepithelial neoplasia ( LGIN ) , 65 cases of high?grade gastric intraepithelial neoplasia (HGIN) and 13 cases of early gastric cancer(EGC). Diagnostic discrepancy, clinical characteristics and influential factors between endoscopic forceps biopsy and endoscopic resection were analysed. Results Of 20 cases of LGIN on EFB, 12 cases were finally diagnosed with ER as a higher grade neoplasia including 7 cases of HGIN (major histological discrepancy rate 35?0%, 7/20) and 5 cases of EGC(major histological discrepancy rate 25?0%, 5/20) . Of 65 cases of HGIN on EFB, 38 cases were finally diagnosed as EGC after ER (58?5%,38/65), 4 as LGIN(6?2%,4/65). Thirteen EGC patients diagnosed with EFB had the same diagnosis with ER. The overall histological diagnostic discrepancy rate between EFB and ER specimens was 55?1%( 54/98) among the enrolled patients. The size more than 2 cm in diameter and the congestive surface were associated with the histological discrepancy between EFB and ER specimens ( P < 0?05 ) . Conclusion The reliability of EFB for the definitive diagnosis of gastric intraepithelial neoplasia is not high as ER, which is not only the main treatment but also a precise histological method for diagnosis.