Objective:To evaluate the performance of rural practitioners of endoscopic cleaning and disinfection participating in the Early Diagnosis and Treatment Program for Upper Gastrointestinal Cancers and to analyze the influencing factors.Methods:The questionnaires for skill assessment were designed based on the skill scheme and clinical practice of the Early Diagnosis and Treatment Program for Upper Gastrointestinal Cancers in rural China, and the App Early diagnosis, Early treatment was used as the examination platform. The practitioners in 539 county hospitals from 25 provinces participating in the program in 2019 were assessed for techniques and skills for endoscopic cleaning and disinfection and the excellence rate was calculated. Multivariate logistic regression model was used to analyze the influencing factors for the examination. Results:A total of 1 671 endoscopic cleaning and disinfection practitioners participated in the assessment with the score of 73.41±16.60. The passing rate was 85.82%, and the excellence rate was 44.94%. Among all questions, the correct rate of "opportunistic screening flow chart" was the highest (98.21%), and that of "the evaluation index for mass screening" was the lowest (57.89%). The multivariate logistic regression analysis showed that the excellence rate was high in practitioners who had a bachelor degree or above ( OR=1.627,95% CI:1.319-2.007, P<0.001), the career for 5 to <15 years (5 to <10 years: OR=1.329,95% CI:1.045-1.689, P=0.020; 10 to <15 years: OR=1.384,95% CI:1.026-1.867, P=0.033), working in eastern and central regions (eastern regions: OR=3.476,95% CI:2.368-5.103, P<0.001;central regions: OR=4.028,95% CI:2.679-6.057, P<0.001) and with full understanding of the screening scheme ( OR=1.547,95% CI:1.246-1.921, P<0.001) . Conclusion:Practitioners on the Early Diagnosis and Treatment Program for Upper Gastrointestinal Cancers in rural China have mastered the basic screening scheme and skills for endoscopic cleaning and disinfection. The education background, duration of the career, area and understanding of screening scheme are influencing factors for the excellence rate of endoscopic cleaning and disinfection.

目的:了解农村上消化道癌早诊早治地区基层项目管理人员的技术能力.方法:由农村上消化道癌早诊早治项目专家组依据国家现行技术方案和项目实践,编写考核试题库,利用"早诊早治"APP建立考试平台,收集2019年参加农村上消化道癌早诊早治项目的27个省的418家县级医疗卫生机构项目管理人员的能力水平考核信息进行描述性分析.结果:共有827名基层项目管理人员完成考核,考核平均分83.07分,合格率96.86％,优秀率78.36％.其中"人群数据管理和安全"答题平均正确率最高,为99.52％;"人群筛查质量控制"答题平均正确率最低,为67.21％.结论:我国农村上消化道癌早诊早治地区基层项目管理人员较好掌握技术方案和具备数据管理能力,文化程度高、东中部地区、疾控中心的项目人员考核优秀的比例更高,应针对技术水平较低的人员和认知薄弱的技术环节加强培训.

目的 探讨农村上消化道癌早诊早治地区病理医师技术能力水平及相关影响因素.方法 以2019-01-01-2019-12-31参与农村上消化道癌早诊早治项目的病理医师为研究对象,由项目专家组依据现行技术方案和项目实例编写考核试题库,利用"早诊早治"APP建立考试平台进行技术能力考核,计算考核优秀率.采用多因素Logistic回归模型分析考核优秀率的影响因素.结果 共纳入1304名病理医师进行分析,考核平均分为75.71,合格率为94.40％(1231/1304),优秀率为36.58％(477/1304).对于各部分考核内容的平均答题正确率,其中"标本处理与病理诊断"为(78.84±8.83)％,"肿瘤病理诊断标准"为(71.70±9.85)％,"人群筛查质控"和"评价指标"分别为(65.37±9.22)％和(68.66±32.32)％.多因素分析结果显示,本科及以上文化程度(OR研究生=2.185,95％CI为1.393～3.428,P=0.001;OR本科=1.702,95％CI为1.155～2.507,P=0.007)、本专业工作5～<10年(OR=1.589,95％CI为1.072～2.356,P=0.021)、参加项目≥2年(OR=1.315,95％CI为1.034～1.672,P=0.026)、东中部地区(OR东部=2.558,95％CI为1.660～3.942,P<0.001;OR中部=2.294,95％CI为1.462～3.601,P<0.001)的病理医师考核优秀率相对较高.结论 我国农村上消化道癌早诊早治地区病理医师基本掌握技术方案,但总体优秀率偏低.文化程度、本专业工作时长、参加项目时长和所在地区是病理医师考核优秀的主要影响因素,应有针对性继续加强病理医师培训.

目的 探讨食管炎症在食管癌发生发展中的作用,为食管癌早诊早治提供参考.方法 从农村上消化道癌筛查数据库中选择2013-2018年首次参加筛查且年龄为40～69岁的54925人作为研究对象,从中选择同一时期内再次参加筛查的18021人,其中首次病理诊断为正常共12126人,作为正常组;诊断为食管炎症共1795例,作为食管炎症组.分别以再次筛查结果为重度异型增生/食管癌和食管癌的数据来分析2组差异.结果 正常组和食管炎症组的性别(x2=16.76,P＜0.001)和年龄(x2=237.12,P＜0.001)分布差异有统计学意义.正常组和食管炎症组的食管重度异型增生/食管癌发病率分别为196.70/10万和285.04/10万,2组食管癌发病率分别为47.85/10万和35.63/10万.调整年龄和性别后,食管炎症组的食管重度异型增生/食管癌发病风险是正常组的1.11倍(Z=0.27,P=0.784),食管癌发病风险是食管正常组的0.61倍(Z=-0.47,P=0.635),差异均无统计学意义.结论 食管炎症在食管癌发生发展中的作用有限,对食管炎症进行干预并不能对食管癌的发病产生明显影响.

目的 评估上消化道黏膜病变及早期癌术前胃镜活体组织检查(简称活检)病理结果和内镜黏膜下剥离术(ESD)术后病理结果的一致性.方法 选取磁县人民医院2017-07-01-2018-06-30胃镜活检病理诊断为上消化道癌前病变及早期癌并行ESD治疗的50例患者为研究对象.对比分析其术前胃镜病理结果与术后ESD病理结果的差异.结果 50例患者,术前活检病理为上皮内瘤变43例,其中低级别上皮内瘤变1例,高级别上皮内瘤变42例(病灶45处);早癌7例.术后最终病理为高级别上皮内瘤变33例;早癌17例(病灶19处),其中黏膜内癌9例(11处病灶).术前活检病理与术后病理诊断符合率为76.9％(40/52),术后病理程度较术前病理严重的占23.1％(12/52),分别占各活检比例的71.1％(32/45)和100.0％(7/7).早癌组活检与术后病理诊断符合率高于上皮内瘤变组,差异有统计学意义,P＜0.05.结论 术前活检病理与术后切除病理结果存在一定差异,术前病理结果对诊断有较好的提示价值,但不能完全代表整个病灶病变程度,对于上皮内瘤变及早期癌应结合内镜给予ESD治疗,在获得准确诊断的同时对病灶早期切除.

目的 分析2018年中国上消化道癌高发区居民癌症防治核心知识的认知现状及其影响因素,为开展肿瘤防治健康宣教工作提供科学依据.方法 2018-04-16-2019-09-23对纳入四川、安徽、河南、山东、江苏、甘肃、河北和湖北省参加中国上消化道癌早诊早治项目,年龄在40～<70岁的14438名筛查人员进行癌症防治核心知识调查,分析癌症防治核心知识知晓率及其影响因素.结果 纳入调查的8个省份平均癌症防治核心知识知晓率为80.42％,其中安徽省居民癌症防治核心知识知晓率最高(86.52％),甘肃省最低(74.77％).在防癌知识的认知情况中,认为癌症早期可没有任何症状者占93.92％,戒烟有助于预防癌症者占95.52％,知晓上消化道癌早诊早治项目的占98.8％,知晓项目是免费的占99.12％,知道上消化道癌早诊早治项目筛查的是食管癌和胃癌两个癌种的占82.53％,知晓胃癌和食管癌有效的早期筛查方法是胃镜+染色+指示性活检者占67.79％,知晓癌症诊断最准确的方法(金标准)是组织病理检查者占64.88％,认为癌症筛查或体检有助于早发现癌症者占95.96％,知晓癌症是可以预防者占88.65％,能接受1年1次健康体检者占83.80％.单因素分析结果显示,性别(χ2=501.637,P<0.001)、年龄(χ2=207.051,P<0.001)、民族(χ2=9.151,P=0.002)、恶性肿瘤家族史(χ2=24.151,P<0.001)、文化程度(χ2=660.546,P<0.001)、家庭年经济收入(χ2=1126.355,P<0.001)均与居民癌症防治核心知识知晓率有关联.多因素分析结果显示,性别(OR=1.130,95％CI为1.100～1.160,P<0.001)、恶性肿瘤家族史(OR=1.354,95％CI为1.169～1.569,P<0.001)、小学(OR=1.227,95％CI为1.163～1.295,P<0.001)、初中及同等学历(OR=1.381,95％CI为1.240～1.538,P<0.001)、高中及同等学历(OR=1.412,95％CI为1.348～1.479,P<0.001)、大专及以上(OR=1.667,95％CI为1.502～1.850,P<0.001)、家庭年经济收入(OR=1.106,95％CI为1.095～1.118,P<0.001)、40～岁(OR=0.884,95％CI为0.869～0.900,P<0.001)和50～岁(OR=0.678,95％CI为0.530～0.867,P<0.001)是居民癌症防治核心知识知晓率的影响因素.结论 应对女性、文化程度较低、无恶性肿瘤家族史、家庭收入低和低龄居民加强癌症防治知识宣教工作,不断提高广大居民癌症防治知识水平,从而增强居民自我防癌意识.

[目的]探究农村上消化道癌早诊早治项目筛查内镜医师专业技术能力现状及其影响因素.[方法]由农村上消化道癌早诊早治项目专家组依据国家现行技术方案和项目实践编写考核试题库,并利用"早诊早治"APP建立考试平台,收集2019年参加农村上消化道癌早诊早治项目的内镜医师基本情况,并对内镜医师技术方案掌握情况和内镜诊疗技术能力进行考核,计算考核优秀率.采用多因素Logistic回归模型分析影响考核优秀率的因素.[结果]共3207名内镜医师完成考核,考核平均分(72.60±15.07)分,合格率87.25％,优秀率33.80％.内镜医师对"人群筛查数据管理和安全"相关内容答题平均正确率最高,为99.16％,对"人群筛查评价指标"内容答题平均正确率最低,为59.73％.多因素Logistic回归分析提示,性别、年龄、文化程度、职称、参加项目时长、所在地区和对技术方案理解程度与考核优秀率相关,女性、年龄小于40岁、研究生文化程度、主治医师及以上职称、参加项目2年及以上、东中部地区以及完全理解技术方案的内镜医师考核优秀率相对较高(P均＜0.05).[结论]我国农村上消化道癌筛查内镜医师基本能够掌握技术方案,但总体优秀率偏低,应针对技术能力水平较低的内镜医师和掌握薄弱的技术环节加强培训.

目的 通过放大胃镜和双焦距胃镜分别联合窄带成像技术(NBI)对胃内病变进行观察,比较其对早期胃癌的诊断效果.方法 纳入2016-06-01-2018-06-30于沧州市人民医院通过普通胃镜发现可疑早期胃癌(直径＜20 mm)的患者837例.其中417例患者(440处可疑病变)采用放大胃镜(ME-NBI组),420例患者(442处可疑病变)采用双焦距胃镜(BE-NBI组),进行调焦联合NBI检查,记录对可疑病灶的内镜下诊断(癌和非癌)及诊断用时,并对所有纳入的可疑病变多点钳取组织送病理检查.结果 本研究共纳入882处病变,经病理确诊为胃癌的病变共79处(9.0％),早期胃癌共62处(7.0％,病理分型Viena Ⅲ型).ME-NBI组有424处内镜下诊断与病理诊断一致(96.4％),高于BE-NBI组的411处(93.0％),两组间差异有统计学意义,P＜0.05.ME-NBI组诊断平均用时25 min,长于BE-NBI组的18 min,两组间差异有统计学意义,P＜0.05.ME-NBI组对癌(Ⅳ～Ⅴ型)和非癌(Ⅰ～Ⅲ型)的诊断受试者曲线下面积(AUROC)为0.936,敏感度和特异度分别为90.2％和97.0％;BE-NBI组AUROC为0.780,敏感度和特异度分别为60.5％和96.0％.ME-NBI组对早期胃癌(Ⅳ型)和非癌(Ⅰ～Ⅲ型)的诊断AUROC为0.924,敏感度和特异度分别为87.9％和97.0％;BE-NBI组AUROC为0.605,敏感度和特异度分别为55.2％和96.0％.结论 双焦距胃镜联合NBI操作简便,诊断用时少,诊断特异度高,可以应用于基层医院.但是因其诊断符合率及准确率低于放大胃镜联合NBI,故双焦距胃镜仍不能替代放大胃镜在早期胃癌诊断中的地位.

目的 分析食管和贲门各级癌前病变及早期癌内镜检出情况,追踪随访食管贲门轻、中度异型增生转归特点.方法 选取2006-07-01-2013-01-31在河北医科大学第四医院行内镜检查的97 637例病例资料作为研究对象,回顾性分析食管贲门癌前病变及早期癌的检出情况,并对329例食管和286例贲门确诊为黏膜轻、中度异型增生的患者行内镜检查随访至2014-10-30,分析食管贲门轻、中度异型增生转归特点.结果 食管和贲门癌前病变及早期癌检出率分别为3.92％和3.43％;食管、贲门癌前病变及早期癌男女检出率分别为5.29％、2.34％和3.99％、2.79％,差异有统计学意义,均P＜0.05;≥50岁与＜50岁组检出率分别为4.56％、2.60％和4.14％、1.98％,差异均有统计学意义,均P＜0.05.233例食管轻度异型增生与96例中度异型增生消退率分别为81.97％和54.17％,维持率分别为12.45％和25.00％,进展率分别为5.58％和20.83％,差异有统计学意义,均P＜0.05.贲门207例轻度异型增生与79例中度异型增生的消退率分别为83.09％和54.43％,维持率分别为10.14％和20.25％,进展率分别为6.76％和25.31％,差异有统计学意义,均P＜0.05.食管轻度异型增生与中度异型增生病变进展间隔中位时间分别为26和12个月,差异有统计学意义,P＜0.05;贲门轻度异型增生与中度异型增生病变进展间隔中位时间分别为23.5和11.5个月,差异有统计学意义,P＜0.05;发生进展的食管与贲门病例中,进展间隔中位时间分别为17和14.5个月,差异有统计学意义,P＜0.05.结论 食管和贲门癌前病变及早期癌患者检出率男性均高于女性,≥50岁患者检出率高于＜50岁患者.食管贲门中度异型增生较轻度异型增生更易发生,进展间隔时间更短.

目的 上消化道癌是我国常见恶性肿瘤之一,发病率和死亡率高于世界平均水平.本研究通过高发现场上消化道癌筛查队列研究,评价内镜筛查对磁县上消化道癌的防治效果,探讨筛查对上消化道癌发病、死亡的影响,为肿瘤防治策略制定提供依据.方法 本研究选用磁县2005-2013年逐年度完成的内镜筛查人群.筛查人群界定为40～69岁目标人群,全部人群建立研究队列数据库,干预组为71923人(男34157人,女37766人),其中参加内镜检查的筛查组为22135人,未筛查组为49788人;对照组为19384人(男9376人,女10008人),所有覆盖人群与对照组人群都通过与肿瘤登记数据库匹配建立数据库,再结合随访观察肿瘤自然发病与死亡情况,肿瘤发病死亡登记应用ICD10统计.分析队列人群中上消化道癌、食管癌、胃癌和全部恶性肿瘤发病和死亡率的相对危险度,进一步比较各组,观察逐年度累积率变化趋势.结果 通过11年随访,相对于对照组,内镜筛查组上消化道癌发病率和死亡率显著降低.干预组人群上消化道癌的发病率和死亡率分别与对照组相比较,相对危险度RR分别为0.83(95％CI为0.76～0.90,P＜0.001)和0.65(95％CI为0.59～0.73,P＜0.001),发病和死亡率均明显低于对照组;干预组中的筛查组与对照组相对危险度比较,其下降更为明显,相对危险度RR分别为0.83(95％CI为0.75～0.93,P＜0.001)和0.48(95％CI为0.41～0.56,P＜0.001),人群上消化道癌早诊早治筛查后对其发病与死亡率下降效果明显.结论 内镜筛查可明显降低高发区上消化道癌死亡风险,有效降低发病风险,且影响效果食管癌优于贲门癌和非贲门胃癌.作为较为成熟的筛查技术,上消化道癌内镜筛查与早诊早治覆盖面的进一步扩大将对降低癌症危害、减轻癌症负担起到积极影响.

目的 冀南山区为癌症高发区,山区中药资源丰富.本研究挖掘区域内抗肿瘤药用植物资源的药用价值,更好发挥抗肿瘤药用植物的临床效用,通过野外实地系统考察,调查冀南山区抗肿瘤药用植物资源状况,筛选具有抗肿瘤作用的药用植物.方法 通过查阅地方志和资源普查成果等相关资料,制定普查路线;沿着线路调查,记录药用植物种类、观测生境、目测多度、采集标本等.走访乡医,了解民间抗肿瘤药用植物应用情况.结果 参阅植物志及相关植物抗肿瘤研究等资料,确定冀南山区抗肿瘤药用植物有128种,分属53科;其中菌类植物5科、14种,蕨类植物1科、1种,裸子植物2科、2种,双子叶植物40科、96种,单子叶植物5科、15种.结论 冀南山区抗肿瘤药用植物资源丰富,其中菌类和双子叶种类比较多,民间应用药用植物抗癌防癌有一定物质基础,为冀南山区抗肿瘤植物资源开发利用提供依据.

Objective:To summarize and analyze the endoscopic screening results of 8,149 asymptomatic patients. Methods:Endoscopic screening data of high-risk people aged 40-69 in Ci county from 2011 to 2013 were reviewed, and the detection rate of upper gastrointestinal cancer and its precancerous lesions and treatment success rate of positive cases in different genders and ages were calculated. Results:A total of 8,149 cases were included in the analysis, inclu-ding 3,424 males and 4,725 females, with a male to female ratio of 0. 72∶1. In total, 174 positive cases were detected, with a detection rate of 2. 14% (109 males, detection rate:3. 18% ;65 females, detection rate:1. 38% ). The early diagnosis rate was 91. 38% , the treatment success rate of 86. 21% , and the treatment success rate of endoscopy was 48. 43% . Among the 174 patients aged 44-70 years (average 60 years), 109 were males and 65 were females, with a male to female ratio of 1. 68∶1. In all cases of upper gastrointestinal cancer, the proportion of patients aged 60 -64 was the highest (35. 06% , 61／174), followed by those aged 55 -59 (27. 01% , 47／174) and 65-69 (20. 11% , 35／174), respectively. A total of 111 positive cases were detected in esopha-gus (63. 79% , 111／174), 42 in cardia (24. 14% , 42／174), and 21 in stomach (12. 07% , 21／174). Conclusion:There are a large number of asymptomatic 40-69-year-olds with upper gastrointestinal cancer and precancerous lesions in Ci Coun-ty where the incidence of esophageal cancer is high. The detection rate is closely related to gender and age. Endoscopic screening for high-risk population can effectively detect upper gastrointestinal cancer and its precancerous lesions from an ear-ly stage, and reduce the incidence and mortality of upper gastrointestinal cancer through timely intervention and treatment.

目的 Bcl-2作为一种癌基因,与肿瘤早期形成密切相关.本研究旨在探讨凋亡抑制基因Bcl-2启动子区-938(C/A)位点单核苷酸多态性(single nucleotide polymorphism,SNP)与河北省南部高发区人群贲门腺癌及其癌前病变遗传易感性的相关性.方法 采用病例对照研究方法,选取2007-12-01-2009-12-30河北省南部食管癌高发区人群195名正常对照者、92例贲门癌前病变患者和169例贲门癌患者组织标本进行研究,应用UNIQ-10柱式动物基因组DNA抽提试剂盒进行组织DNA提取,并通过聚合酶链式反应-限制性片段长度多态性分析(polymerase chain reaction-restriction fragment length polymorphism,PCR-RFLP)方法检测Bcl-2-938位点基因型,随机选取不同基因型的标本进行DNA测序,分析该位点多态性与贲门癌及癌前病变的遗传易感性关系.结果 Bcl-2启动子区-938位点CC基因型频率分别为48.5％、47.8％和33.8％,差异有统计学意义,均P＜0.05.携带CC基因型的个体与AA基因型相比,贲门癌(P=0.009)与癌前病变(P=0.020)的发病风险增加,经性别、年龄、吸烟和家族史校正后的OR值分别为2.564(95％CI=1.268～5.184)和2.810(95％CI=1.179～6.639).贵门癌患者组吸烟者比例为56.8％,高于癌前病变组的43.5％和对照组的34.4％,差异有统计学意义,x2=18.446,P＜0.001;而吸烟阳性组中与AA基因型相比,携带CC基因型(P=0.020)可增加贲门癌的发病风险,经性别、年龄、家族史和饮酒校正后的OR值为3.635(95％CI=1.226～10.777).结论 Bcl-2-938位点CC基因型可显著增加河北省食管癌高发区人群贲门癌及癌前病变的遗传易感性和发病风险.

Objective: To describe the status of non-steroidal anti-inflammatory drugs (NSAIDs) use in areas with a high incidence of upper gastrointestinal cancer in China. Methods: This study was based on the National Key Research and Development Program of "National Precision Medicine Cohort of Esophageal Cancer" and "Study on Identification and Prevention of High-risk Populations of Gastrointestinal Malignancies (Esophageal cancer, Gastric cancer and Colorectal cancer)" . From January 2017 to August 2018, 212 villages or communities with a high incidence of esophageal cancer or gastric cancer were selected from 12 regions in 6 provinces. A total of 35 910 residents aged between 40 and 69 years old who met the inclusion criteria and signed the informed consent were investigated and enrolled in this study. The use of NSAIDs, demographic characteristics, health-related habits, height, weight, and blood pressure were collected by the questionnaire and physical examination. The status of main NSAIDs (aspirin, acetaminophen and ibuprofen) use with the difference varying in genders, age groups and regions were analyzed by using χ(2) test and Cochran-Armitage trend analysis method. Results: Of 35 910 subjects, the mean age was (54.6±7.1) years old and males accounted for 43.42% (15 591). The overall prevalence of NSAIDs intake was 4.56% (1 638), but it significantly varied in different provinces (P<0.001). The overall prevalence of NSAIDs intake was 4.87% (1 750) in females, which was significantly higher than that in males 4.24% (1 524) (P<0.001). The prevalence of NSAIDs intake increased with age (P for trend <0.001). As the frequency of NSAIDs intake increased, the incidence of gastrointestinal symptoms, gastrointestinal ulcers and black stools increased (P for trend <0.05 for all). Conclusion: The use of NSAIDs is prevalent in some areas with a high incidence of upper gastrointestinal cancer in China. The increased use of NSAIDs may lead to more adverse effects related to the gastrointestinal tract.

Objective:To investigate the occurrence of upper gastrointestinal cancer and precancerous lesions in asympto-matic population in Ci County. Methods:From 2005 to 2018, People's Hospital of Ci County carried out gastroscopy for 27,994 asymptomatic people aged 40-69 in 7 villages in Ci County. Lesion biopsy was taken for pathological examination and diagnosis. Results:The number of new cases of esophageal cancer, gastric cardia cancer and gastric cancer were 243, 95 and 26, that of those cancers' precancerous lesions were 2,819, 345 and 213, and that of early esophageal cancer, gas-tric cardia cancer and gastric cancer were 194, 56 and 20, which accounting for 83% , 59% and 77% of their corresponding cancers. Esophageal cancer and gastric cardia cancer accounted for 92. 7% of upper gastrointestinal cancers in this area. Conclusion:Esophageal cancer and gastric cardia cancer are upper gastrointestinal cancers that seriously threaten the physi-cal and mental health of people in this region. Endoscopic screening of asymptomatic population, which is an important measure for cancer prevention in the region, has greatly improved the early diagnosis and treatment of upper gastrointestinal cancers.

Objective: To investigate the association between the promoter region-938 polymorphism of B-cell lymphoma/leukemia-2 (Bcl-2) gene and the esophageal cancer (EC) and gastric cardia adenocarcinoma (GCA) in Hebei Province. Methods: From 2007 to 2010, 145 esophageal cancer patients and 169 cardiaccancer patientsfrom the outpatient department of the Fourth Hospital of Hebei Medical Universitywereselected in a case group, and 195 non-tumor patients were selected in a control group during the same period. A questionnaire survey was used to collect information of research subjects. Pathological tissues were collected to extract genomic DNA and detect the genotype of bcl-2 gene -938. A multivariate logistic regression model was used to analyze the association between the bcl-2 gene locus 938 CC genotype and the EC and GCA. The interaction between age, gender, smoking, drinking, upper gastrointestinal family history and the bcl-2 gene locus 938 CC genotype was analyzed by likelihood ratio test. Results: The age of the esophageal and cardiac cancer groups was (56.3±8.3) and (57.1±8.4) years old, and that of the control group was (54.7±7.1) years old. The proportion of the bcl-2 gene locus 938 CC genotype in the esophageal group [48.3% (70/145)] and the cardiac cancer group [48.5% (82/169)] was higher than that in the control group [33.8% (66/195)] (both P values<0.05).Compared with the AA genotype, the risk of esophageal cancer and cardiac cancerin people with the CC genotype was 2.386 (1.20-4.76) and 2.564 (1.27-5.18) respectively. In the population with CC genotype, compared with the positive family history, drinking, and male, the negative family history, non-drinking, and female had a higher risk of esophageal cancer; compared with the non-smoking, negative family history, non-drinking and male, the smoking, positive family history, drinking, and female had a higher risk of cardiac cancer (all the P interaction values were <0.05). Conclusion: People with bcl-2 gene locus 938 CC genotype in Hebei Provincewere more likely to suffer from the esophageal and gastric cardia adenocarcinoma.

目的 组氨酸三聚体核苷结合蛋白1基因具有明显的肿瘤抑制作用,本研究旨在探讨食管胃交界癌前病变及早期癌中HINT1启动子区CpG岛甲基化状态及临床意义.方法 提取2012-2-1-2013-12-30河北医科大学第四医院诊治的食管胃交界癌前病变、早期癌及进展期癌共184例病变组织及45例正常对照组织基因组DNA.根据Siewert分型分为TypeⅠ型、TypeⅡ型和TypeⅢ型.TypeⅠ型包括Barrett食管31例(BE组)、食管远端高级别上皮内瘤变及早期癌16例(EHIN及EEC组)、食管腺癌18例(EA组);TypeⅡ型包括贲门低级别上皮内瘤变23例(CLIN组)、贲门高级别上皮内瘤变及早期癌30例(CHIN及CEC组),贲门腺癌36例(CA组);TypeⅢ型包括近端胃低级别上皮内瘤变14例(SGLIN组)、近端胃高级别上皮内瘤变及早期癌12例(SGHIN及SGEC组),近端胃癌4例(SGA组).采用甲基化特异性PCR(methyl-ation specific polymerase chain reaction,MSP)检测上述组织中HINT1基因启动子区CpG岛甲基化状态,对比分析HINT1基因甲基化与食管胃交界不同癌变阶段的相关性.结果 (1)TypeⅠ型:BE组、EHIN及EEC组、EA组和对照组甲基化发生率分别为12.9％(4/31)、43.8％(7/16)、50.0％(9/18)和0,EHIN及EEC组HINT1基因甲基化率显著高于对照组(χ2=6.64,P=0.007)和BE组(χ2=5.601,P=0.029),与EA组比较差异无统计学意义(χ2=0.133,P=0.716).(2)TypeⅡ型:CLIN组、CHIN及CEC组、CA组和对照组甲基化率分别为34.8％(8/23)、53.3％(16/30)、55.6％(20/36)和6.7％(1/15),CHIN及CEC组和CA组HINT1基因甲基化率显著高于对照组(χ2=9.265,P=0.002),CHIN及CEC组、CA组和CLIN组比较差异无统计学意义(χ2=2.697,P=0.260).(3)TypeⅢ型:SGLIN组、SGHIN及SGEC组、SGA组和对照组甲基化率分别为21.4％(3/14)、66.7％(8/12)、75.0％(3/4)和6.7％(1/15),SGHIN及SGEC组与对照组(χ2=10.80,P=0.003)和SGLIN组(χ2=5.418,P=0.045)比较差异均有统计学意义.结论 HINT1基因启动子区异常甲基化可能与食管胃交界腺癌发生发展相关,提示三者可能存在相似的分子机制.

目的 消化道早期癌内镜诊疗逐渐受到重视,对消化道癌前病变及早期癌的治疗产生了深远影响.找寻安全有效的治疗方式是目前临床对早期癌及癌前病变患者的研究热点.本研究总结近年来本中心内镜下治疗的500例癌前病变及早期癌病例资料,评估内镜治疗上消化道黏膜病变的有效性和安全性.方法 回顾性分析2011-07-01-2018-12-31磁县人民医院28例采用氩离子凝固术(argon plasma coagulation,APC)、22例采用多环套扎黏膜切除术(multi-band mucosectomy,MBM)、350例采用黏膜切除术(endoscopic mucosalresection,EMR)和100例采用黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗的上消化道黏膜病变患者的临床资料,并对比分析4种方法在病灶大小、手术时间、并发症、随访结果及成本效益方面的差异.结果 ESD组直径大小为(8.0±5.0)cm、MBM和EMR组为(5.0±2.0) cm,APC组为(3.0±1.5) cm;ESD组手术时间为(120±20) min,MBM和EMR组为(30±15) min,APC组为(20±10) min;ESD组病灶完全消除率为99.00％(99/100),MBM组为95.45％(21/22),EMR组为94.29％ (330/350);ESD组术后出血及穿孔并发症发生率为5.00％(5/100),EMR组为0.57％(2/350),P=0.002;MBM组和APC组未出现出血及穿孔等并发症;术后随访复查ESD组和MBM组未见局部复发,EMR组局部复发率为4.29％(15/350),APC组复发率为10.71％(3/28),P=0.124;ESD组手术成本为6 500元/例,MBM组为3 800元/例,EMR组为3 850元/例,APC组为650元/例.结论 对于直径≤3.0 cm而内镜下评估位于黏膜层的病灶,应用MBM、EMR和APC的方法均可以有效消除病灶,并缩短手术时间,降低医疗费用.而对于直径＞3.0 cm和经过内镜评估病变较深或多次活检后内镜下注射抬举不良的病灶,宜采取ESD的手术方式.

目的 了解DLEC1基因启动子区甲基化状态在食管胃结合部癌变过程中的作用,以及高级别上皮内瘤变(HGIN)经内镜治疗后组织甲基化状态的改变.方法应用甲基化特异性聚合酶链反应(MSP)方法检测食管胃结合部的22例正常组织、27例低级别上皮内瘤变(LGIN)组织,34例HGIN组织、28例腺癌组织以及20例HGIN经内镜治疗后组织的甲基化状态,并进行统计学分析.结果 腺癌组织、HGIN组织、LGIN组织、正常组织的甲基化率分别为60.71%、58.82%、55.56% 和9.09%,HGIN经内镜治疗后组织为10.00%.腺癌组织、HGIN组织及LGIN组织三者之间差异无统计学意义.LGIN组织甲基化率显著高于正常组织,两者差异有统计学意义.HGIN组织甲基化率显著高于HGIN经内镜治疗后组织,两者差异有统计学意义.HGIN经内镜治疗后组织甲基化率与正常组织比较,差异无统计学意义.结论 LGIN组织甲基化率显著高于正常组织,而癌组织、HGIN组织及LGIN组织三者间无明显差异,提示DLEC1启动子区甲基化状态是食管胃结合部腺癌发生的相关因素之一,与疾病进展无明显关系.HGIN组织甲基化率显著高于HGIN经内镜治疗后组织,也提示DLEC1启动子区甲基化状态与食管胃结合部腺癌的发生相关.HGIN经内镜治疗后组织甲基化率与正常组织无明显差异,提示切除病灶部位组织的甲基化状态已恢复至正常组织水平.

目的 研究食管癌及癌前病变中DLEC1基因启动子区的高甲基化状态,并进一步观察食管重度非典型增生/原位癌组织(EDYSⅢ/CIS)病变在内镜微创治疗后甲基化状态的改变.方法 采用甲基化特异性PCR(MSP)方法检测食管鳞状细胞癌组织(ESCC),EDYSⅢ/CIS,食管轻、中度非典型增生粘膜组织(EDYSⅠ～Ⅱ),食管正常粘膜组织(ENT)启动子区甲基化率并比较之间的差异,同时进一步比较EDYSⅢ/CIS病变在内镜治疗前后甲基化率的改变.结果 所有标本均成功进行了MSP检测,将完全甲基化及半甲基化归为甲基化进行统计.ESCC甲基化率为75.0％,与EDYSⅢ/CIS 61.11％相比差异无统计学意义(P>0.05);EDYSⅢ/CIS组织甲基化率明显高于EDYSⅠ～Ⅱ34.62％及食管重度非典型增生/原位癌经内镜下切除修复后组织(EDYSⅢ/CISAR)9.52％,差异有统计学意义(P<0.05);EDYSⅠ～Ⅱ组织甲基化率高于ENT组织7.69％,差异有统计学意义(P<0.05).结论 DLEC1启动子区甲基化状态可能参与食管鳞癌的发生、发展.