Lin C K, Lai K H, Lo G H, Cheng J S, Hsu P I, Mok K T, Tseng H H
Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 2001 Jun;64(6):331-6.
Cathepsin E is found mainly over the gastric surface and foveolar epithelial cells, and it also is found in the metaplastic pyloric glands and cancer cells. The exact function of cathepsin E in gastric mucosa remains unclear. The colonic type (type III) of intestinal metaplasia (IM) is strongly associated with intestinal-type gastric carcinoma. IM is considered to be a precancerous lesion. The aim of this study was to find out the role of cathepsin E in IM, dysplasia and cancer of stomach.
Sixty nine biopsy specimens with IM and dysplasia and 33 gastrectomy specimens with gastric carcinoma were fixed, sectioned and stained with PAS-alcian blue stain, high iron-diamine alcian blue stain to classify IM and immunohistochemical stain to localize cathepsin E. Those patients with dysplastic gastric lesions received regular endoscopic follow-up.
Fifteen of 69 patients with gastric dysplasia developed cancer in a median 10.5 months follow-up. Severe dysplasia developed carcinoma significantly higher than mild dysplasia (12/20 vs. 1/25, p < 0.001), and type III intestinal metaplasia seemed to have significantly predilection for severe dysplasia and gastric cancer. Cathepsin E was stained in intestinal metaplasia with dysplastic change in 44/69 specimens (63.8%), and carcinoma in 28/48 (58.3%) specimens, there was no significant difference between intestinal type and diffuse type carcinoma in cathepsin E staining. The positive staining for cathepsin E decreased significantly in severe dysplastic gastric mucosa.
Type III IM is commonly associated with severe dysplasia and cancer; it may be a precancerous lesion. The positive staining of cathepsin E decreased with the severity of gastric dysplasia, representing dedifferentiation of the cells.
组织蛋白酶E主要存在于胃表面和胃小凹上皮细胞，也存在于化生的幽门腺和癌细胞中。组织蛋白酶E在胃黏膜中的具体功能尚不清楚。结肠型（III型）肠化生（IM）与肠型胃癌密切相关。IM被认为是一种癌前病变。本研究的目的是探讨组织蛋白酶E在胃IM、发育异常和癌症中的作用。
69例有IM和发育异常的活检标本以及33例胃癌胃切除标本进行固定、切片，并用PAS-阿尔辛蓝染色、高铁二胺阿尔辛蓝染色对IM进行分类，免疫组化染色定位组织蛋白酶E。那些有发育异常胃病变的患者接受定期内镜随访。
69例胃发育异常患者中有15例在中位随访10.5个月时发生癌症。重度发育异常发展为癌的比例显著高于轻度发育异常（12/20对1/25，p<0.001），III型肠化生似乎对重度发育异常和胃癌有显著的偏好。44/69例（63.8%）有发育异常改变的肠化生标本中组织蛋白酶E呈阳性染色，28/48例（58.3%）癌标本中呈阳性染色，组织蛋白酶E染色在肠型和弥漫型癌之间无显著差异。在重度发育异常的胃黏膜中，组织蛋白酶E的阳性染色显著降低。
III型IM常与重度发育异常和癌症相关；它可能是一种癌前病变。组织蛋白酶E的阳性染色随胃发育异常的严重程度而降低，代表细胞的去分化。
