摘要目的 探讨Barrett食管(BE)活检标本的临床病理学特点及与近端胃肠化黏膜的鉴别诊断.方法 按WHO标准选取BE标本38例,观察病理组织学特征,对38例BE、44例近端胃肠化黏膜进行免疫组织化学CK7、CK20、CK4、CK8、S100P、MUC6、COX2、bcl-2观察,并用荧光原位杂交(FISH)方法检测hTERC基因情况.结果 BE和近端胃肠化黏膜中CK7、CK20、MUC6、COX2、bcl-2表达差异无统计学意义(P＞0.05).S100P阳性表达在BE与近端胃肠化黏膜间差异有统计学意义(P＜0.05)；BE中CK7与CK4、CK7与CK8表达结果呈正相关(P＜0.05).近端胃肠化黏膜中CK7与CK4、CK7与CK8表达结果均无相关性(P＞0.05)；使用FISH方法检测两组标本hTERC基因的表达情况,BE组阳性率为57.9％(22/38),而近端胃肠化黏膜阳性率为13.6％ (6/44),两者差异有统计学意义(P＜0.05).结论 在鉴别BE和近端胃肠化黏膜中CK7与CK20表达的意义尚不能肯定；而CK7/CK4/CK8同时阳性可能支持BE的诊断,对鉴别两者有一定作用.S100P有可能作为鉴别BE和近端胃肠化黏膜两者的免疫标志物；hTERC基因扩增检测可能有助于BE诊断,并提示BE向食管腺癌发展的过程中该基因可能起重要作用.

abstractsObjective To study the clinicopathologic features and differential diagnosis of proximal gastric mucosa and mucosa of Barrett's esophagus (BE) in biopsy specimens.Method Thirty-eight cases of Barrett's esophagus (diagnosed using WHO criteria) and 44 cases of proximal gastric mucosa were studied by immunohistochemistry (for CK7,CK20,CK4,CK8,S-100 protein,MUC6,COX2 and bcl-2) and fluorescence in-situ hybridization (FISH) (for hTERC gene).The pathologic features were analyzed.Results The differences in expression of CK7,CK20,MUC6,COX2 and bcl-2 between BE and proximal gastric mucosa with intestinal metaplasia were not statistically significant (P ＞ 0.05).There was however a statistically significant difference in expression of S-100 protein (P ＜ 0.05).The expression of CK7/CK4 and CK7/CK8 in BE showed positive correlation (P ＜ 0.05).However,such correlation was not demonstrated in proximal gastric mucosa(P ＞ 0.05).The results of hTERC gene expression by FISH showed a statistically significant difference between the two groups:57.9％ (22/38) in BE and 13.6％ (6/44) in proximal gastric mucosa (P ＜ 0.05).Conclusions The significance of CK7 and CK20 expression is uncertain in the differential diagnosis between BE and proximal gastric mucosa.On the other hand,positivity for CK7/CK4/CK8 may support the diagnosis of BE and play a role in distinguishing between the two groups.S-100 protein expression and detection of hTERC gene amplification also contribute to the diagnosis of BE.