目的 研究慢性胃病及胃癌患者胃黏膜中p27蛋白及细胞凋亡指数(AI)的表达水平,探讨p27蛋白及AI的表达与胃癌演变的关系.方法 选择消化科门诊胃镜检查患者黏膜活检标本共155例,其中慢性非萎缩性胃炎32例、慢性萎缩性胃炎25例、肠上皮化生30例、非典型增生32例、胃癌36例.采用免疫组织化学SP法检测慢性非萎缩性胃炎、慢性萎缩性胃炎、肠上皮化生、非典型增生及胃癌组患者胃黏膜中p27蛋白与AI的表达水平并进行临床分析.结果 P27蛋白阳性染色呈黄色或棕黄色颗粒,定位于细胞核,在胃癌组织浅表部位着色相对较强,而深部着色较弱.随着慢性非萎缩性胃炎、慢性萎缩性胃炎、肠上皮化生、非典型增生、胃癌的演变规律,P27蛋白表达水平呈现逐级减低,两两组间比较差异有统计学意义(P<0.05).凋亡细胞阳性染色定位于细胞核内,浓缩的核质紧贴于核膜或核质呈现均匀染色,其周围无炎性反应,随着慢性非萎缩性胃炎、慢性萎缩性胃炎、肠上皮化生、非典型增生、胃癌的演变规律,AI在前3个阶段呈现逐级升高,至肠上皮化生最高,之后的2个阶段逐级下降,慢性非萎缩性胃炎、慢性萎缩性胃炎、肠上皮化生两两组间比较差异无统计学意义(P>0.05),肠上皮化生、非典型增生与胃癌两两组间差异有统计学意义(P<0.05).胃黏膜P27蛋白表达水平与非萎缩性胃炎、慢性萎缩性胃炎、肠上皮化生、非典型增生、胃癌疾病类型呈负相关(r=-0.976,P<0.01),AI表达水平与上述疾病类型无相关性(r=0.060,P>0.05).P27蛋白表达水平及AI均与年龄、性别、肿瘤部位及大小无相关性(P>0.05).结论 P27蛋白在胃黏膜中的表达水平及细胞凋亡与慢性胃病、胃癌前病变、胃癌的发生发展有关,其在胃癌的演变过程中起着重要的作用.%Objective To study the expression of p27 protein and apoptosis index in gastric mucosa of patients with chronic gastric diseases and patients with gastric cancer, and to explore the relationship between the expression of p27 protein in gastric cancer and the evolution of AI. Methods A total of 155 mucosal biopsy specimens including 32 cases of chronic nonatrophic gastritis, 25 cases of chronic atrophic gastritis, 30 cases of intestinal metaplasia, 32 cases of atypical hyperplasia and 36 cases of gastric cancer from outpatients were enrolled in the study. The expression levels of p27 protein and apoptosis index ( AI) were detected by immunohistochemical SP method. Results Yellow or brown granules were located in the nucleus in gastric cancer tissues, with relatively weak staining in superficial layer and relatively strong staining in deeper layer. The expression levels of P27 protein were gradually decreased with the progression of disease. There were significant differences between the groups each other (P<0. 05). The positive staining of apoptotic cells were located in the nucleus, with condensed cytoplasm against the nuclear membrane or stained evenly, without inflammatory reaction around. With the progression of disease ( chronic nonatrophic gastritis, chronic atrophic gastritis, intestinal memplasia, atypical hyperplasia, gastric cancer) , AI was increased gradually in the first three stages, then decreased gradually in the last stages, and there were no significant differences between the first three groups each other (P > 0. 05),however, there were significant differences between the last three groups each other (P<0. 05). In addition, the expression of p27 protein in gastric mucosa of the patients was negatively related to the type of disease (r=0. 976,P<0. 01). However there was no correlation between the expression levels of AI and the type of disease (r=0. 060,P>0. 05),moreover, the expressions levels of p27 protein and AI were not correlated with patient's age, gender, the location and size of the tumor (P>0. 05). Conclusion The expression levels of P27 protein and cell apoptosis are related with the pathogenesis and development of chronic gastric diseases, gastric precancerous lesions and gastric cancer, which play an important role in the evolution of gastric cancer.
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