Anti M, Marra G, Armelao F, Percesepe A, Ficarelli R, Ricciuto G M, Valenti A, Rapaccini G L, De Vitis I, D'Agostino G
Department of Internal Medicine, Catholic University, Rome, Italy.
Gut. 1993 Apr;34(4):525-30. doi: 10.1136/gut.34.4.525.
To determine whether proliferative patterns in flat rectal mucosal samples can predict the recurrence of adenomatous colorectal polyps, after polypectomy, biopsy specimens from normal looking rectal mucosa were obtained at endoscopy from 55 patients diagnosed for the first time as having adenomatous colorectal polyps. Epithelial cell proliferation was assessed in biopsy specimens through 3H-thymidine autoradiography. After polypectomy, patients were followed for 24 months and underwent complete colonoscopy every 6 months to detect and remove any metachronous lesions. In 40 patients second biopsy specimens were taken during one of the follow up colonoscopies to evaluate the stability of proliferative indices over time. The ratio of labelled (S phase) to total cells (labelling index) for the entire crypt, as well as ratios for each of the five equal compartments into which the crypt had been divided longitudinally, was calculated for each patient. Mean labelling indices for upper crypt compartments 3 and 4 + 5 in the 22 patients in whom polyps recurred were significantly higher (respectively p < 0.05 and p < 0.01) than those of the 33 without recurrence suggesting that an upward shift of the crypt's replicative compartment is associated with polyp recurrence. Labelling indices remained essentially unchanged in those patients who underwent biopsy twice. Reproducible kinetic parameters such as these might be useful in planning follow up of patients with adenomatous polyps after polypectomy.
为了确定直肠扁平黏膜样本中的增殖模式是否能够预测腺瘤性大肠息肉切除术后的复发情况，对55例首次诊断为患有腺瘤性大肠息肉的患者在内镜检查时从看似正常的直肠黏膜获取活检标本。通过³H-胸腺嘧啶核苷放射自显影术评估活检标本中的上皮细胞增殖情况。息肉切除术后，对患者进行24个月的随访，每6个月进行一次全结肠镜检查，以检测并切除任何异时性病变。在40例患者中，在随访期间的一次结肠镜检查时获取第二次活检标本，以评估增殖指数随时间的稳定性。计算每位患者整个隐窝的标记（S期）细胞与总细胞的比例（标记指数），以及隐窝纵向划分的五个相等部分各自的比例。息肉复发的22例患者隐窝上部3区以及4 + 5区的平均标记指数显著高于未复发的33例患者（分别为p < 0.05和p < 0.01），这表明隐窝复制区的上移与息肉复发相关。接受两次活检的患者标记指数基本保持不变。这样可重复的动力学参数可能有助于制定腺瘤性息肉患者息肉切除术后的随访计划。
