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目的:检测食管癌前病变组织端粒酶活性,结合病理细胞学检查,观察端粒酶活性改变对预后的影响.方法:用以PCR为基础的端粒重复序列扩增法检测端粒酶活性.胃镜检查过程中发现可疑病变107例,活检留取组织标本,同时送病理细胞学和端粒酶检查.对癌前病变患者胃镜监督随访2a.结果:首次胃镜检查诊断食管癌36例,32例端粒酶阳性,癌前病变71例,13例端粒酶阳性,从食管慢性炎症→轻度非典型增生→中度非典型增生→重度非典型增生,各阶段端粒酶阳性率分别为6.1%(2/33),15.3%(2/13),33.3%(5/15),40%(4/10),中—重度非典型增生患者阳性率显著增高.对癌前病变患者随访过程中,8例拒绝随复杂胃镜,1例移居外地,1例意外死亡,61例完成随访,12例端粒酶阳性患者5例癌变3例愈合,49例阴性患者2例癌变24例愈合,两组预后存在显著差异,P=0.002.结论:食管癌前病变中,部分端粒酶阳性,阳性率与组织分型相关.随访中绝大多数癌变患者表现为端粒酶阳性,端粒酶活性增加将标志食管癌的发生.
OBJECTIVE: To detect the telomerase activity in esophageal precancerous lesions and to observe the effect of telomerase activity on prognosis by pathological cytology.Methods: Telomerase activity was detected by PCR-based telomeric repeat amplification .There were 107 cases of suspicious lesions detected by gastroscopy and biopsy specimens were collected and pathological cytology and telomerase examination were performed.At the endoscopy surveillance of patients with precancerous lesions follow-up2a.Results: The first gastroscopy diagnosis of esophageal cancer in 36 cases, 32 Cases of telomerase positive, precancerous lesions in 71 cases, 13 cases of telomerase positive, from chronic inflammation of the esophagus → mild atypical hyperplasia → moderate atypical hyperplasia → severe atypical hyperplasia, the positive rates of telomerase in each stage were The positive rate of patients with moderate-severe atypical hyperplasia was significantly higher than that of patients with pre-malignancy (6.1%, 2/33), 15.3% (2/13), 33.3% (5/15) and 40% (4/10) During the course of treatment, 8 patients refused to go with complicated gastroscope, 1 patient had died in the field, 1 patient died of accidental death and 61 patients were followed up. Among the 12 patients with telomerase positive reaction, 5 patients had healed in 3 patients and 49 patients had negative patient in 2 patients. There was significant difference between the two groups in the prognosis, P = 0.002 .Conclusion: In esophageal precancerous lesions, some telomerase positive, positive rate and Woven type related follow-up in the vast majority of cancer patients showed positive telomerase, telomerase activity increase will mark esophageal cancer.