【摘要】 目的 :探讨河南食管癌高发区无症状居民食管贲门交界部齿状线变化特征及其与食管贲门癌变的关系 ,进一步验证作者的假设 :即齿状线上移可能是该地区人群食管贲门交界部腺癌发生的重要早期改变之一。方法 :对河南食管癌高发区林州市和获嘉县 12 17例无症状居民 (≥ 30岁 )进行纤维内镜普查 ,粘膜活检和组织病理学检查。记录纤维内镜下齿状线的改变 (上移 ,不规则 ,不清晰 )并与组织病理学结果进行比较分析。活检组织均经体积分数为 85 %酒精固定 ,常规组织学石蜡包埋和HE染色。结果 :齿状线上移 (≥ 3cm) ,不规则和不清晰的检出率分别为 12 % ,10 %和 1%。男性各年龄组齿状线上移和不规则的检出率均明显高于相同年龄组女性患者 (P <0 .0 5 ) ,并随年龄增长 ,均呈现逐渐下降的趋势。女性 4 0～ 4 9岁年龄组齿状线不规则检出率明显高于其他年龄组(P <0 .0 5 )。齿状线不清晰检出率明显低于齿状线上移和不规则的检出率。齿状线上移患者食管下段发生基底细胞过度增生和间变的频率明显高于无齿状线上移的人群 ,而中段食管基底细胞过度增生无明显改变 ,但齿状线上移患者间变发生率明显升高 (P <0 .0 5 )。齿状线上移患者贲门慢性浅表性胃炎 ,慢性萎缩性胃炎伴肠上皮化生的发生率较无齿状线上移为高。结论 :河南更多还原

【Abstract】 Aim: To characterize the appearance of Z line and its correlation with esophageal and gastric lesions on symptom free subjects from the high incidence area for esophageal cancer in Henan Province,and to test our hypothesis that upgrowth of Z line may be one of the important early changes in carcinogenesis of adenocarcinoma at the gastroesophageal junction. Methods: Endoscopy, mucosal biopsy and histopathology examination was performed on 1 216 symptom free subjects (≥30 years old ) from the high incidence area for esophageal cancer in Linzhou and Huojia, Henan Province. Z line appearance was recorded as upgrowth, irregular, and indistinct. The endoscopic observation was correlated with histopathological results .All the biopsies were fixed with 85% alcohol and processed for routine histopathology and HE staining.Results: The detection rates for the upgrowth (≥3cm),irregular and indistinct Z line were 12%,10%and 1%,respectively. The incidence for Z line upgrowth and irregular in male adults at different age groups was apparently higher than that in female adults ( P <0.05).The incidence for irregular Z line in young female (40～49) adults was higher than in other age groups ( P <0.05).With the increasing in age,a decreasing tendency for Z line upgrowth was observed both in male and female. The subjects with Z line upgrowth had a higher incidence for esophageal basal cell hyperplasia and dysplasia in lower esophageal segment than in those without Z line upgrowth. The higher incidence for dysplasia was also observed in middle esophageal segment from the subjects with Z line upgrowth ( P <0.05). The incidence for chronic superficial gastritis, atrophic gastritis with intestinal metaplasia was higher in the subjects with Z line upgrowth compared to those without Z line upgrowth .Conclusion:It is identified that there is an apparent change of Z line upgrowth in symptom free subjects from the high incidence area for esophageal cancer in Henan. Z line upgrowth was related with both esophageal and gastric cardia lesions, suggesting that Z line upgrowth may be one of the characteristic changes in this population.The present observations provide new insight for understanding of esophageal and gastric cardiac carcinogenesis.更多还原