【摘要】 目的探讨Hath1基因在不同病变组织中的表达,分析其在增生性息肉(HP)和无蒂锯齿状腺瘤/息肉(SSA/P)鉴别诊断中的意义。方法选择2015年4月—2019年12月于成都三六三医院接受结肠镜检查的患者,对其影像资料进行回顾分析。共筛选出35例HP、63例SSA/P、3例SSA/P伴异型增生、5例传统锯齿状腺瘤(TSA)、10例管状腺瘤(TA)患者纳入本次研究,并选取15例正常结肠为对照组。利用免疫组化法检测Hath1在不同组织中的表达情况并进行比较。结果在正常组织中,Hath1染色见于间质性炎症细胞、隐窝细胞和上皮细胞的细胞核,染色强度一致。在HP组织中,Hath1染色见于所有的微泡和杯状细胞的隐窝内的细胞核,且强度与对照组相当,并且Hath1在HP黏膜脱垂的扭曲隐窝中的核染色强度也保持一致。而在SSA/P组织中,56例(91.8%)隐窝细胞核Hath1染色非常微弱或缺失,5例(8.2%)隐窝细胞核Hath1染色阳性的组织均来自左侧(直肠3例,乙状结肠2例)。在不同病灶定位(右侧结肠vs左侧结肠)(χ~2=31.452,P<0.01)或疾病类型(HP vs SSA/P)(χ~2=53.157,P<0.01)中Hath1染色阳性率的差异具有统计学意义(P<0.01)。此外,在伴有细胞学异常增生的SSA/P组织中,Hath1在发育不良的上皮细胞质中的表达呈弥漫性阳性着染。在TSA组织中,Hath1表达呈混合模式,同时有局灶性的表达缺失和强阳性核染色。在TA组织中,Hath1的表达为大部分的强阳性的核染色,同时伴有部分斑片状阴性表达。结论在HP和SSA/P组织中Hath1基因的表达强度对鉴别诊断具有较高的特异性和敏感性,有望辅助单纯形态学难以区分病例的确诊,值得深入研究。更多还原

【Abstract】 Objective To investigate the value of Hath1 gene in the identification of sessile serrated adenoma/polyp(SSA/P) and hyperplastic polyp(HP). Methods A total of 63 cases of SSA/P, 35 cases of HP, 5 cases of traditional serrated adenoma(TSA), 10 cases of tubular adenoma(TA) and 3 cases of SSA/P with dysplasia were selected as the research objects, and 15 cases of normal colorectal tissues as control. The expression of Hath1 was detected. Results In normal colonic mucosa, Hath1 showed consistent nuclear staining in epithelial cells, crypt cells and interstitial inflammatory cells in the lamina propria. In HP, Hath1 was stained with nuclei in the crypts of microbubbles(28/28, 100%)and goblet cells(7/7, 100%), and the staining intensity was similar to that of normal colonic mucosa. The nuclear staining intensity of Hath1 was also consistent in the twisted recess of hyperplastic polyp mucosal prolapse. However, in most of the SSA/P cases(53/58, 91.4%), the expression of Hath1 in the crypt was missing or very weak. The positive sections of crypt nucleus in the remaining 5 cases were all from the left side(3 cases of sigmoid colon and 2 cases of rectum). There was a significant difference in the positive rate of Hath1 staining between SSA/P and HP or polyps. In addition, in SSA/P with cytological dysplasia, Hath1 often showed diffuse positive staining in the dysplastic epithelial cytoplasm. In TA, most of Hath1 was strongly positive, but negative in some patchy areas. In TSA, the expression of Hath1 in polyps also showed mixed pattern, focal strong nuclear staining and focal loss of expression. Conclusion The expression degree of Hath1 gene has high sensitivity and specificity in the differential diagnosis of SSA/P and HP, and has the potential to become an objective means to assist in the diagnosis of cases which are difficult to be distinguished by morphology, which is worthy of further study.更多还原