Objective To investigate the relationship between chronic gastropathy with intestinal metaplasia (IM) and caudal type homeobox genes 2 (Cdx2),tumor necrosis factor-α (TNF-α),Helicobacter pylori (Hp) infection.Methods Onehundred and thirty patients underwent gastroscopy were divided into 2 groups by typical pathological type:gastritis group (30 cases) and IM group [100 cases,including mild IM group (30 cases),moderate IM group (35 cases),severe IM group (35 cases)].Hp infection was confirmed.The expressions of Cdx2 and TNF-α protein was evaluated by immunohistochemistry.Results The positive expression rates of Cdx2 and TNF-α protein in IM group were significantly higher than those in gastritis group [78.0％(78/100) vs.6.7％(2/30),60.0％(60/100) vs.16.7％(5/30)],and there were statistical differences (P ＜ 0.01).The positive expression rates of Cdx2 and TNF-α protein in positive and negative Hp infection in IM group were significantly higher than those in gastritis group [Cdx2 protein:79.4％(50/63) vs.1/10,75.7％(28/37) vs.5.0％(1/20);TNF-α:74.6％(47/63) vs.4/10,35.1％(13/37)vs.5.0％ (1/20)],and there were statistical differences (P ＜ 0.01).The positive expression rate of Cdx2 protein in moderate IM group and severe IM group were significantly higher than those in mild IM group [80.0％ (28/35) and 97.1％ (34/35) vs.53.3％ (16/30)],in severe IM group were significantly higher th.an those in moderate IM group,and there were statistical differences (P ＜0.05).There were no statistical differences in the positive expression rate of Cdx2 protein of difference Hp infection among the 4 groups (P＞0.05).There were no statistical differences in the positive expression rate of TNF-α protein between mile IM group and moderate IM group (P ＞ 0.05).The positive expression rate of TNF-α protein in severe IM group was significantly higher than that in mild IM group and moderate IM group [80.0％(28/35) vs.40.0％(12/30) and 57.1％(20/35)],and there were statistical differences (P ＜ 0.05).The positive expression rate of TNF-α protein of positive Hp infection patients in gastritis group,mild IM group,moderate IM group and severe IM group were significantly higher than those of negative Hp infection patients (4/10 vs.1/20,47/63vs.13/37,10/18 vs.2/12,15/21 vs.5/14,22/24 vs.6/11),and there were statistical differences (P ＜ 0.05).Conclusions The expressions of Cdx2 and TNF-α protein and Hp infection are closely related with IM.Therefore,testing the level of Cdx2 and TNF-α protein expressions can help to judge the degree of IM,which provides a basis for reversing IM.%目的 探讨慢性胃病伴肠上皮化生(IM)与尾型同源异型盒基因2(Cdx2)、肿瘤坏死因子α(TNF-α)蛋白表达及幽门螺杆菌(Hp)感染间的关系.方法 行胃镜检查并活检患者130例,依据典型病理分型分为胃炎组(30例)、IM组[100例,包括轻度IM组(30例)、中度IM组(35例)、重度IM组(35例)],检查每组Hp感染情况,免疫组织化学方法检测Cdx2、TNF-α蛋白表达情况.结果 IM组Cdx2、TNF-α蛋白阳性表达率明显高于胃炎组[78.0％(78/100)比6.7％(2/30)、60.0％(60/100)比16.7％(5/30)],差异有统计学意义(P＜0.01);而且IM组Hp阳性和阴性时Cdx2、TNF-α蛋白阳性表达率均明显高于相应胃炎组[Cdx2蛋白:79.4％(50/63)比1/10、75.7％ (28/37)比5.0％(1/20),TNF-α:74.6％ (47/63)比4/10、35.1％(13/37)比5.0％(1/20)],差异有统计学意义(P＜0.01).中度IM组和重度IM组Cdx2蛋白阳性表达率明显高于轻度IM组[80.0％(28/35)和97.1％(34/35)比53.3％(16/30)],重度IM组高于中度IM组,差异均有统计学意义(P＜0.05);四组内不同Hp感染情况时Cdx2蛋白阳性表达率比较差异均无统计学意义(P＞0.05).轻度IM组与中度IM组TNF-α蛋白阳性表达率比较差异无统计学意义(P＞0.05),重度IM组TNF-α蛋白阳性表达率明显高于轻度IM组和中度IM组[80.0％(28/35)比40.0％(12/30)和57.1％(20/35)],差异均有统计学意义(P＜0.05);胃炎组、轻度IM组、中度IM组、重度IM组内Hp阳性患者TNF-α蛋白阳性表达率明显高于Hp阴性患者(4/10比1/20、47/63比13/37、10/18比2/12、15/21比5/14、22/24比6/11),差异均有统计学意义(P＜0.05).结论 Cdx2、TNF-α蛋白表达及Hp感染与IM程度关系密切,故监测Cdx2、TNF-α蛋白表达水平有助于判断IM程度,并为如何逆转IM提供了一定依据.
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