Rantanen T, Honkanen T, Paavonen T, Rantanen L, Oksala N
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.
Eur J Surg Oncol. 2011 Feb;37(2):168-74. doi: 10.1016/j.ejso.2010.10.013. Epub 2010 Nov 20.
Gastro-oesophageal reflux disease (GERD) is a risk factor for oesophageal adenocarcinoma. Although fundoplication cures reflux symptoms and oesophagitis, it remains controversial whether it is capable of preventing the development of oesophageal adenocarcinoma. Hsp27 and Hsp70 are associated with the development of cancer, whereas the effect of fundoplication on them is not known.
The expression of Hsp27 and Hsp70 was assessed semiquantitatively from biopsies of oesophageal mucosa for a prospective cohort of 19 patients with GERD treated with fundoplication and 7 controls without GERD. Upper gastrointestinal endoscopy with biopsies from the oesophagogastric junction (EGJ) and the distal and proximal oesophagus were performed preoperatively (19 patients) and after recovery from GERD at 6 (19 patients) and 48 months (16 patients) postoperatively.
The expressions of both Hsp27 (p = 0.001) and Hsp70 (p = 0.002) in the distal oesophagus were lower in patients preoperatively and at 48 months postoperatively (p < 0.001 for both) than in controls. The patients' Hsp27 and Hsp70 levels were lower preoperatively in the proximal oesophagus (p = 0.048 for both) than in controls. Both Hsp27 (p = 0.002) and Hsp70 (p = 0.003) were lower in the distal oesophagus preoperatively and at 48 months postoperatively (p = 0.003 for Hsp27, p = 0.004 for Hsp70) than in the proximal oesophagus.
Our results indicate that there may be some factor interfering with the mucosal defence system of the distal oesophagus in GERD that is uninfluenced by fundoplication and not associated with the acid-reflux-normalizing effect.
胃食管反流病（GERD）是食管腺癌的一个危险因素。尽管胃底折叠术可治愈反流症状和食管炎，但它是否能够预防食管腺癌的发生仍存在争议。热休克蛋白27（Hsp27）和热休克蛋白70（Hsp70）与癌症的发生有关，而胃底折叠术对它们的影响尚不清楚。
对19例接受胃底折叠术治疗的GERD患者和7例无GERD的对照者的前瞻性队列，从食管黏膜活检标本中对Hsp27和Hsp70的表达进行半定量评估。术前（19例患者）以及术后6个月（19例患者）和48个月（16例患者）从GERD恢复后，进行上消化道内镜检查，并从食管胃交界（EGJ）以及食管远端和近端取活检标本。
术前和术后48个月时，患者食管远端的Hsp27（p = 0.001）和Hsp70（p = 0.002）表达均低于对照组（两者p均<0.001）。患者食管近端术前的Hsp27和Hsp70水平均低于对照组（两者p = 0.048）。术前和术后48个月时，食管远端的Hsp27（p = 0.002）和Hsp70（p = 0.003）均低于食管近端（Hsp27为p = 0.003，Hsp70为p = 0.004）。
我们的结果表明，在GERD中可能存在某种干扰食管远端黏膜防御系统的因素，该因素不受胃底折叠术影响，且与酸反流正常化效应无关。
