摘要:
Objective To study the rules of the expression of oncogene APC, Bcl-2, K-ras, Ki-67 and Cox-2 and their roles in the course of occurrence and development in melanosis coli(MC) and colorectal carcinoma and its precancerous lesion,and to explore MC relation to assess their risks of cancer. Methods All of 445 patients selected by colonoscopy, histopathology and special staining confirmed were divided into five groups. Immunohistochemistry method was used to examine the expression of APC, Bcl-2, K-ras, Ki-67 and Cox-2 in MC 108 cases, ulcerative colitis (UC) 69 cases, colorectal polyps(CP) 122 cases, colorectal carcinoma (CRC) 96 cases and 50 subjects of normal colorectal mucosa. Results The positive expression rate of Bcl-2,K-ras of the older MC group 51. 4 % (36/70) ,41. 4% (29/70) was significantly higher than that of young and middle-aged MC group 26. 3% (10/38) , 21. 1% (8/38) ( P 0. 05). Conclusion Apoptosis and mutation of cell mucosal are related to elderly patients with MC, the patients with MC compared with those of normal mucosa, ulcerative colitis and colorectal polyps, the cells mucosal apoptosis and mutation of MC are possible between normal mucosa and precancerous lesions. For the patients with MC and polyps,the active colonoscopy,histopathology and immunohistochemical examination should be carried on as early as possible. Periodical follow-up is necessary,the controlling strategies of MC is practical and can improve level of the diagnosis and treatment of early colorectal carcinoma in primary hospital.%目的 研究结肠黑变病(MC)黏膜组织大肠癌相关癌基因(APC、Bcl-2、K-ras、Ki-67)和环氧化酶2(Cox-2)表达的变化,与结肠癌、癌前病变之间的比较,探讨 MC病变癌变的风险.方法 本研究纳入445例患者,根据肠镜检查和病理结果分为5组.MC组108例,对照组分为4组:溃疡性结肠炎(UC)组69例,大肠息肉(CP)组122例,大肠癌(CRC)组96例,正常黏膜组50例.均行黏膜组织相关癌基因(APC、Bcl-2、K-ras、Ki-67) 和Cox-2的免疫组化检测.结果 Bcl、K-ras阳性表达率,MC老年组51.4%(36/70)、41.4%(29/70)显著高于MC中青年组26.3%(10/38)、21.1%(8/38)(P0.05).结论 MC老年病人与中青年相比,细胞黏膜凋亡与突变相关性大;MC与正常黏膜、UC、CP比较,MC细胞黏膜凋亡与突变可能性介于正常黏膜与癌前病变之间.为此,临床应重视MC,尤其MC 伴息肉,通过肠镜下活检行黏膜组织大肠癌相关癌基因监测,可提高基层医院早期大肠癌的诊治水平,可作为切实可行的MC防治策略.