【作者】 王少军；

【导师】 胡乃中；

【作者基本信息】 安徽医科大学 ， 内科学， 2010， 硕士

【摘要】 目的研究大肠息肉癌变过程中的相关因素,探讨大肠高危腺瘤及癌变息肉的临床及内镜病理特征,为合理的结肠镜检查随访提供依据。并研究decorin在大肠腺瘤中的表达情况,探讨decorin与息肉恶变倾向的关系。方法选择安徽医科大学第一附属医院消化科2005-2008年间肠镜下切除并经病理证实符合诊断标准的大肠息肉患者583例(部分来自普外科手术病例)。采用统一设计的个案登记表格,详细记录其临床病理信息,对获得的资料进行整理归纳,按照2006年美国《大肠息肉切除术后随访指南》将大肠息肉患者进行风险分层,即分为低危腺瘤、高危腺瘤及非腺瘤性息肉组,采用回顾性分析的方法对三组和癌变息肉进行临床病理分析。同时,从上述病例中选取我院病理科完整存档蜡块86例包括炎性和增生性息肉病例16例,腺瘤70例进行免疫组化S-P法染色,检测decorin在大肠息肉组织中的表达情况。另选取手术病理证实的大肠癌标本18例,正常大肠黏膜标本20例作为对照观察。结果1.大肠高危腺瘤及癌变息肉的临床分析583例大结肠息肉患者中,非腺瘤性息肉243例,低危腺瘤83例,高危腺瘤257例。腺瘤性息肉组平均年龄58.90±13.28岁,高于非腺瘤性息肉组55.51±15.66岁(P<0.05)；腺瘤性息肉组中其息肉直径≥1cm及数目≥3个者均高于非腺瘤性息肉组(分别为62.0%Vs21.5%,24.1%Vs14.0%,P均<0.01)；腺瘤性息肉癌变率为9.1%,非腺瘤性息肉是0.8%(P<0.001)。高危腺瘤组较低危腺瘤组其便血症状增多(51.8%Vs37.3%,P<0.05),在内镜下更易观察到黏膜改变和表面分叶情况(P<0.05)。本组33例大肠息肉发生癌变,其中息肉直径≥2.0cm的和数目≥3个的息肉癌变率分别为21.1%和11.2%,均显著高于息肉直径≥1.Ocm者(4.2%,P<0.001)和数目<3个者(4.3%,P<0.05)；表面分叶的息肉癌变率为19.3%,高于无表面分叶的息肉癌变率(2.2%,P<0.001)；息肉癌变在绒毛状腺瘤为26.8%,绒毛管状腺瘤为21.1%,管状腺瘤2.3%,绒毛状腺瘤和管状绒毛状腺瘤的癌变率均显著高于管状腺瘤(P均<0.001)。2.Decorin在大肠腺瘤中的表达Decorin在正常组织和非腺瘤性息肉以及管状腺瘤组织中呈高表达(高表达率分别为90.0%,87.5%,84.4%),均高于含绒毛状结构腺瘤(63.2%)和大肠癌组织(44.4%)(P均<0.05)；decorin在伴低级别上皮内瘤变的腺瘤中高表达率为92.0%,显著高于伴高级别上皮内瘤变的腺瘤(53.3%)(P<0.05)；在6例癌变腺瘤中,decorin的高表达率仅为33.3%,显著低于无癌变的腺瘤76.6%(P<0.05)。Decorin的表达与腺瘤的含绒毛状结构与异型增生程度相关。结论高危腺瘤较低危腺瘤其便血症状增多,在内镜下更易观察到黏膜改变和表面分叶等形态学改变,具备高危因素如腺瘤体积越大、数目越多、含绒毛成分多及呈分叶或菜花状者越易发生癌变；Decorin的表达与腺瘤的含绒毛状结构与异型增生程度相关,decorin蛋白的检测可能是一种有价值的指标用于息肉恶性程度的评价。更多还原

【Abstract】 Objective Give a research to the canceration factors for colorectal polyps and to investigate the endoscopic and pathologic characteristics of colorectal high-risk adenomas for a reasonable follow-up colonoscopy. To investigate the expression of decorin in colorectal adenomas,otherwise to analyze the relationship of the expression with clinicopathologic and risk factors.Methods 583 colon polyp patients who underwent colonoscopic resection between 2005 and 2008 at the department of gastroenterology,the first affiliated hospital of anhui medical university (some cases underwent surgical resection)were analyzed retrospective. According to the 2006 postpolypectomy colonoscopy surveillance guideline,583cases with colonic polyps were stratified at their baseline into lower risk group,increased risk group and non-adenomatous polyps group,moreover,undertook statistical treatment to related clinical parameter.Immunohistochemical methods(S-P) were used to detect decorin protein in 16 inflammatory or hyperplastic polyps and 70 colorectal adenomas paraffinembedded tissue specimens,18 colon cancer and 86 colon polyps tissue as control groups.Results 1.Clinical analysis of colorectal advanced adenomas The number of patients with colonic polyps was 583, including 243 non-adenomatous polyps,83 low-risk adenomas,257 high-risk adenomas. The average age of adenomatous polyps patients was older than that of the non-adenomatous polyps patients(58.90±13.28 vs 55.51±15.66,P<0.05);Compared with non-adenomatous polyposis, adenomatous polyposis is significantly diferent in size and number of polyps, adenomatous polyps Patients whose polyps≥lcm and≥3adenomas was more than non-adenomatouss polyps patients (62.0%Vs21.5%,24.1%Vs14.0%,P<0.01,respectively),and there was a significant difference the incidence in cancerous polyps than in non-adenomatous polyps patients (9.1%vs0.8%, P<0.001).The high-risk adenomas has higher incidence of hematochezia (51.8%Vs37.3%,P<0.05),more lobular and mucosal pathological change than low-risk adenomas.33 cases were cancerated in our study, in which, canceration rate of polyps≥2.0cm in diameter and the number of polyps≥3were 21.1% and 11.2%, were significantly higher than those polyps≥1.0cm in diameter (4.2%, P＜0.001) and the number of<3 (4.3%, P<0.05); there was a higher canceration rate for the polyps with Surface lobulation(19.3%),than their with non-Surface lobulation(2.2%)(P＜0.001);The canceration rate of villous adenoma(26.8%) and tubular-villous adenoma (21.1%)was higher than tubular adenoma (2.3%) (P＜0.001, respectively).2.Expression of decorin in colon polyps Normal tissue and non-adenomatous polyps and the majority of tubular adenomas showed strong expression of decorin in the stroma(high expression rates were 90.0%,87.5%,84.4%, respectively),adenomas with villous features and the high grade colon intraepithelial neoplasia and adenocarcinoma showed moderate and very low decorin immunoreactivity(high expression rates were 63.2%,53.3%%,44.4%) (P<0.05, respectively);In the 6 cases of malignant adenomas, high decorin expression rate was only 33.3%, significantly lower than non-cancerous adenomas 76.6%(P<0.05).Decorin expression levels were significantly related to histological features and dysplasia grade of adenomas.Conclusion The high-risk adenomas has higher incidence of hematochezia,more lo-bular and mucosal pathological change than low-risk adenomas. The totality of evidence suggests that multiplicity, size, villous features, and more lobular and mucosal path-ological change are predictors of future advanced adenomas or cancers;The test of expression of decorin protein is helpful in assessing the malignant extent of colorectal polyps更多还原