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目的 探讨胃癌浸润转移的病变机制。方法 采用免疫组化LSAB法检测 2 0例正常胃组织及 96例胃癌标本中ColⅣ、LN、FN的表达。结果 ColⅣ、LN、FN免疫反应物呈棕色均匀分布在胃腺体周围形成线状基底膜样结构。在增生的纤维组织中则呈不规则条纹状表达。 2 0例正常胃组织的腺体周围基底膜结构均匀、完整 ,基本无间质增生。在 96例胃癌组织中 ,腺体周围基底膜结构遭到明显的破坏 ,呈现断线状、条索状、甚至碎片状表达 ,且出现不同程度的间质增生。本研究表明 :临床晚期的 (39 6 % )、分化程度较低的 (36 5 % )、大体浸润型的 (5 3 1% )、以浸润方式生长的 (6 3 5 % )及出现淋巴结转移的 (6 9 8% )胃癌组 ,基底膜明显缺损及间质明显增生程度大于临床中早期的、中高分化的、大体局限型的、以膨胀方式生长的及未发生淋巴结转移的胃癌组 (全部P <0 0 5 )。结论 胃癌恶性程度的高低与胃腺体周围基底膜结构是否完整有必然联系 ,其浸润转移必首先破坏基底膜。细胞外间质纤维组织的增生一方面可为胃癌细胞浸润生长提供依托 ,另一方面也反映了机体对抗和限制肿瘤转移的一种趋势。提示ColⅣ、LN、FN的免疫组化检测可以作为临床判断胃癌恶性程度、淋巴转移趋势及评估其预后的有价值指标。
Objective To explore the mechanism of invasion and metastasis of gastric cancer. Methods The expression of ColIV, LN and FN in 20 normal gastric tissues and 96 gastric cancer specimens were detected by immunohistochemistry. Results The ColIV, LN and FN immunoreactive substances were brown and evenly distributed around the gastric glands to form a linear basement membrane-like structure. In the hyperplasia of fibrous tissue, there is an irregular stripe-like expression. In 20 cases of normal gastric tissue, the basement membrane around the gland was uniform and complete, with almost no interstitial hyperplasia. In 96 cases of gastric cancer, the basement membrane structure around the gland was significantly damaged, showing broken line, cord-like, and even fragment-like expression, and there were different degrees of interstitial hyperplasia. This study showed that: clinically advanced (39.6%), less differentiated (36.5%), generally infiltrating (5.31%), infiltrating (63.5%), and lymph node metastases. In the (69%) gastric cancer group, the significant defect of the basement membrane and the significant hyperplasia of the stroma were greater than those of the early-stage, moderately-differentiated, largely-differentiated, inflated, and non-lymphoid metastases-stricken gastric cancer groups (all P <0 0 5 ). Conclusion The degree of malignancy of gastric cancer is inevitably related to the integrity of the basement membrane structure around the gastric gland, and its invasion and metastasis must first destroy the basement membrane. The proliferation of extracellular stromal fibrous tissue can provide support for invasive growth of gastric cancer cells on the one hand, and it also reflects a tendency of the body to resist and limit tumor metastasis on the other hand. This suggests that the immunohistochemical detection of ColIV, LN and FN can be used as a valuable indicator for judging the degree of malignancy, lymph node metastasis, and evaluating the prognosis of gastric cancer.