【摘要】 目的：探讨胃粘膜肠化和异型增生与胃癌发生的关系及其意义。方法：对７２例胃癌、５７例胃粘膜异型增生、２５６例肠化生病例进行粘液组织化学、菜豆凝集素（ＰＨＡ）亲合组织化学及抗人胃癌单抗ＭＧｄｌ免疫组织化学（ＡＢＣ法）研究，１５例正常胃粘膜作为对照。结果：Ⅲ型肠化在癌旁肠化及异型增生伴肠化的检出率均显著高于萎缩性胃炎伴肠化（Ｐ均＜００１）。ＰＨＡ受体及ＭＧｄｌ抗原在正常胃粘膜无表达，而在胃癌高度表达。ＰＨＡ受体及ＭＧｄｌ抗原表达率在异型增生组织中，中度及重度增生显著高于轻度增生（Ｐ均＜００５或００１）；在肠化组织中，Ⅲ型肠化显著高于Ⅰ、Ⅱ型肠化（Ｐ均＜００５或００１），而与异型增生组织无差异（Ｐ均＞００５）。结论：Ⅲ型肠化和异型增生与胃癌的发生关系密切，二者皆应视为胃癌的癌前病变。对胃镜活检发现的Ⅲ型肠化和异型增生，尤其是对其中具有ＰＨＡ受体和ＭＧｄｌ抗原表达者，应作为胃癌高危人群密切随访更多还原

【Abstract】 Aims:To investigate the relationship between intestinal metaplasia (IM),dysplasia,and gastric cancer(GC),and to evaluate the significance of IM and dysplasia as precursors of GC.Methods: Gastric specimens of 72 gastric carcinoma ,57 dysplasia and 256 IM were investigated with mucin histochemical staining,lectin-binding histochmical staining of phaseolus vulgaris agglutimin (PHA),and ABC Immunohistochemical staining of MGdl ,a monoclonal antibody against human GC.15 cases of normal gastric mucosa were used as control.IM was classified into three subtypes :one complete type IM:(type I),and two types of incomplete IM(type Ⅱ and type Ⅲ ) depending on the absence or presence of sulphomucin in mucin secreting colummar cells.Results:the prevalance of type　Ⅲ IM in IM specimens from mucosa adjacent to GC and from dysplasia was significantly higher than that from chronic atrophic gastritis (P<0.01 ,respectively).PHA receptors and MGdl antigens were not shown in normal gastric mucosa but highly expressed in GC tissue.In dysplasia ,the moderate and the severe dysplasia showed significantly higher expression rate of PHA receptors and MGdl antigens than the mild one(P<0.05-0.01,repectively).Of Variants of IM,the expression rates of PHA receptors and MGdl antigens in type Ⅲ IM were significaltly higher than those in type Ⅰ and type Ⅱ IM (P<0.05-0.01,respectively),but similar to those in dysplasia (P>0.05,respectively).Conclusion:Type Ⅲ IM and dysplasia are closely related to the development of GC,and both of these lesions should be considered as precancerous lesions of stomach.The presence of type Ⅲ IM and dysplasia ,Particularly those with PHA receptors and MGdl antigens,in gastric biopsies should prompt close surveillance as increased risk of developing gastric cancer.更多还原