A Study On Microstructural Changes Of Gastric Mucosa Under Magnifying Endoscopy And Their Correlation With Pathology And Expression Of HTERTmRNA

Objective:To explore the diagnostic value of magnifying endoscopy in the identification of microstructural changes of gastric mucosa and Helicobacter pylori induced gastritis and to study the relationships between these changes and expression of hTERTmRNA in patients with gastric carcinoma and precancerous lesiosn and Helicobacter pylori induced gastritis.Methods: 106 patients were included in the study, they all had upper digestive symptom and were examined by the same senior doctor using magnifying endoscopy.Real-time diagnosis was made during the examination ,forceps biopsies were taken for histopathological examination and detected Helicobacter pylori using Warrthin-Starry method and examine expression of human telomerase reverse transcriptase mRNA by using real-time quantitative PCR, at the same time ¹³C-urea breath test was carried out, when both of Warrthin-Starry method and ¹³C-urea brest test were positive, Helicobacter pylori infection was diagnosed. The morphology of gastric pits under magnifying endoscopy were classified as follows:type A: round spot pits, type B: linear, type C: sparsely and thickly linear, typed D: patchy, and type E:villous. The magnified views of Helicobacter pylori induced gastritis mucosa were classified into 4 types:Z₀,collecting venules with true capillary network,and gastric pits resembling pin holes;Z₁,gastric pits with irregular true capillaries but no collecting venules observed;Z₂white gastric pits,with neither collecting venules nor true capillaries being seen;Z₃,dilated pits with surrounding redness.Results: 1 .Positive correlation was found between gastric pits types A, B, C, D, E and the severity of gastritis, Pearson=0.762, p<0. 05; 2. Intimate relationship werefound between the 5 gastric pit patterns and intestinal metaplasia and dysplasia, Pearson=0.524 and 0.547 separately, p<0. 05; 3.Both of sensitivity and distinction have no significant difference in diagnosing chronic superficial gastritis using magnifying endoscopy and common endoscopy, but in diagnosing chronic atrophic gastritis, significant differences were found in both of sensitivity and distinction, x2 = 16. 725 and 17. 533 separately, /j<0.01; 4.There were high aggrement between magnifying endoscopy and pathology in diagnosing superficial gastritis and chronic atrophic gastritis,Kappa=0.837 and 0.822 separately; 5. Gastritis became more severity as the order of Zo, Z\, Z2, Z3 in Hp induced gastritis, x2=138. 621, p< 0.01, Pearson=0. 77; 6.The expressions of hTERTmRNA were found in both of chronic atrophic gastritis and gastric cancer, and significant diffenence was found between them, / =3.245, p<0. 01, the expression of hTERTmRNA increased with the development of the disease from intestinal metaplasia to dysplasia and gastric cancer,/r=5.762, p<0. 01. 7.The expression of hTERTmRNA were distinctly higher in Hp positive gastric mucosa than in negative cases /=2.689, p<0. 05;8. The expressions of hTERTmRNA in mucosa were significantly difference among the pit patterns B, C, D and E, F=3.274, p<0.05; compared with the expression of hTERTmRNA in gastric cancer, about 67% pit type E can diagnose gastric cancer.Conclusions:!.The microstructural changes of gastric mucosa under magnifying endoscopy can reflect the severity of gastric disease, the value of magnifying endoscopy is much higher than that of common endoscopy in diagnosing early gastric cancer and precancerous lesion;2. hTERT is a very important factor during the development of gastric cancer,Hp infection can cause gastric epithelial cell immortal via telomerase activated and then lead to gastric cancer;3. hTERT is a very important marker for diagnosis of gastric carcinoma, it is useful to follow up patients with high expression of hTERTmRNA and pit type E under magnifying endoscopy for predicting the malignant change potential of gastric precancerous lesions.