Lu Xue-feng, Wang Zun-song, Li Yong-chang, Fu Jin-dong
Digestive Department, Qilu Hospital of Shandong University, Jinan 250012, China.
Zhonghua Nei Ke Za Zhi. 2006 Jan;45(1):17-20.
To explore the diagnostic value of magnifying endoscopy and human telomerase reverse transcriptase (hTERT) in identifying precancerous lesions of gastric mucosa.
154 patients with upper digestive symptoms were included in the study. They were examined by the same senior doctor using magnifying endoscopy, and real-time diagnosis was made during the examination. Forceps biopsies were taken for pathological examination and were examined the expression of human telomerase reverse transcriptase mRNA (hTERT mRNA) by real-time quantitative PCR. The morphology of gastric pits under magnifying endoscopy was classified as follows: type A: round spot pits, type B: linear, type C: sparsely and thickly linear, typed D: patchy, and type E: villous.
The divergence of intestinal metaplasia had significant differences implications among the gastric pit patterns from B to E under magnifying endoscopy (chi(2) = 17.58, P < 0.05). The more sever the intestinal metaplasia, the higher the pattern scale of the gastric pit (Pearson = 0.531, P < 0.05). The degree of dysplasia had a parallel relationship with the gastric pit patterns changed from C to E (chi(2) = 10.256, P < 0.05, Pearson = 0.549, P < 0.05). The expressions of hTERT mRNA of mucosa had significant differences among the gastric pit patterns B, C, D and E (F = 3.274, P < 0.05); If the expression of hTERT mRNA were taken as diagnostic criteria of gastric cancer, 65% of pit type E would be considered as gastric cancer which were otherwise negative by pathology.
The micro-structural changes of gastric mucosa under magnifying endoscopy can reflect the severity of gastric disease, hTERT is a very important marker for diagnosis of gastric carcinoma. It is useful to predict the malignant change of gastric precancerous lesions in patients by following up high expression of hTERT mRNA combined with pit type E diagnosed by magnifying endoscopy.
探讨放大内镜及人端粒酶逆转录酶（hTERT）在胃黏膜癌前病变诊断中的价值。
纳入154例有上消化道症状的患者。由同一位资深医生使用放大内镜对其进行检查，并在检查过程中进行实时诊断。钳取组织进行病理检查，并通过实时定量PCR检测人端粒酶逆转录酶mRNA（hTERT mRNA）的表达。放大内镜下胃小凹形态分类如下：A型：圆点样小凹；B型：线状；C型：稀疏粗线状；D型：斑片状；E型：绒毛状。
放大内镜下胃小凹形态从B型到E型，肠化生的差异具有显著意义（χ² = 17.58，P < 0.05）。肠化生越严重，胃小凹形态分级越高（Pearson = 0.531，P < 0.05）。异型增生程度与胃小凹形态从C型到E型的变化呈平行关系（χ² = 10.256，P < 0.05，Pearson = 0.549，P < 0.05）。胃小凹形态B、C、D、E型黏膜的hTERT mRNA表达有显著差异（F = 3.274，P < 0.05）；若将hTERT mRNA表达作为胃癌诊断标准，65%的E型小凹会被视为胃癌，而病理检查结果为阴性。
放大内镜下胃黏膜的微观结构变化可反映胃部疾病的严重程度，hTERT是胃癌诊断的重要标志物。通过随访放大内镜诊断为E型小凹且hTERT mRNA高表达来预测胃癌前病变患者的恶变情况具有重要意义。
