| Verrucosa gastritis is a special type of chronic gastritis and the diagnosis can be easily discovered by endoscope.The presentation is in the gastric body or(and)antrum have multiple.The central of the small hummocky uplift is umbilical kind of depression and the surface is erosive.H.pylori infection is considered to be one of the causes of verrucosa gastritis.Chronic infection of H.pylori is the main risk factor of gastric cancer.In 1994,H.pylori has been listed as the first kind of carcinogenic factor by the world health organization.P53 is a tumor suppressor gene that identified earliest.It is a suppressor gene that has the highest correlation with human tumor ever found.It plays an important role in regulating cell cycle and cell apoptosis,when dealing with the various damage signal,the level of P53 increases rapidly.When the gastric mucosa of gastritis patients progresses to intestinal metaplasia,dysplasia and cancer,the mutation frequency of p53 gene increases.Lgr5 is an isolated G protein coupled receptor.It is a Wnt target gene.It has been identified as a new kind of stem cell marker of the mouse small intestine,colon and hair follicles.Recently it is found that it also expressed in the human stomach.Lgr5 positive cells have the ability of self-renewal and can build the longevity gastric antrum unit in the body,thus accord with the standard of stem cells.Lgr5 positive cells are mainly in the base of gastric antrum glands,in the chronic non-atrophic gastritis and chronic atrophic gastritis and gastric cancer,the expression of Lgr5 is increased.After chronic infected with H.pylori,the mucosa lesion begin in the gastric antrum.When H.pylori migrate to the gastric body,it can cause stomach body mucosal to be atrophic,the absence of chief cell and parietal cell,gastric acid reduction and intestinal metaplasia.In verrucous gastritis patients,it is likely to have the rule of colonization transfer of H.pylori infection.H.pylori may be located in the antrum at the beginning and cause verrucous lesions in tne antrum which leading to the change of the local PH,wich result to the survival environment of gastric antrum is not suitable for H.pylori,so H.pylori change colonial part to the stomach body,and cause the local lesion.In chronic gastritis,atrophy,intestinal metaplasia and neoplasia often in the mucosal of gastric angle and the body side and that is also the common location of gastric cancer.This study choosed the verrucous gastritis patients with H.pylori positive,study the rule of H.pylori colonization density and the mucosa pathological changes in the the verrucous lesions of gastric antrum and gastric angle.Lgr5 is the mark of the mucosa stem cells and P53 is the mark of mucosal neoplasia.To observe if there is a transfer of colonization of helicobacter pylori infection in verrucous gastritis patients and if there is a certain inner link among H.pylori colonization transfer and Lgr5 positive cells and P53 protein expression.Objective: This study is trying to detect mucosal pathological,H.pylori colonization density and the expression of Lgr5 and P53 in the gastric antrum and gastric angle of verrucous lesions,in order to study the inner link among H.pylori colonization transfer and Lgr5 positive cells and P53 protein expression and to provide the best site of clinical examination gastric mucosal precancerous lesions and to actively prevent the occurrence of gastric cancer.Methods: Take a biopsy in the verrucous lesions of gastric antrum and gastric angle of the VG patients who are breath test positive before the endoscopic examination.Observe the pathologic grading by HE staining.The degree of inflammation(0,+,++,+++),activity(0,+,++,+++),intestinal metaplasia(0,+,++,+++),degree of atrophy(0,+,++,+++).Observe the H.pylori colonization density by giemsa staining(0,+,++,+++).Detect the expression of Lgr5 and P53 by immunohistochemical staining and analyze the immunohistochemical images by Imagepro plus 6.0 image analysis software.Results:1 Comparison of H.pylori colonization density,pathological and the expression of Lgr5 and P53 between different partsIn pathological examination of the verrucous lesions of gastric antrum and gastric angle in the 27 VG patients,the comparison of degree of inflammatory gastritis and intestinal metaplasia between different parts has no statistically significance(P>0.05).The comparison of gastritis activity between different parts shows that the gastritis activity of the verrucous lesions of gastric antrum is significantly higher than that of the gastric angle(P<0.05).The comparison of atrophy between different parts shows that gastric atrophy degree of the gastric angle is significantly higher than that of the verrucous lesions of gastric antrum(P<0.05).The comparison of H.pylori colonization density between different parts shows that the H.pylori colonization density of the verrucous lesions of gastric antrum is significantly higher than that of the gastric angle(P<0.05).The comparison of the expression of P53 between different parts shows that the expression of P53 of the verrucous lesions of gastric antrum is significantly higher than that of the matching gastric angle(P<0.05).The comparison of the expression of Lgr5 between different parts has no statistical significance(P>0.05).2 Comparison of H.pylori colonization density and pathological in the verrucous lesions of gastric antrum and gastric angleThe comparison of the H.pylori colonization density among different inflammation degree in the verrucous lesions of gastric antrum and gastric angle both shows significant difference(P<0.05).In the correlation analysis,it shows positive correlation both in the verrucous lesions of gastric antrum and gastric angle(P<0.05).Comparison of H.pylori colonization density among different intestinal metaplasia degree in the verrucous lesions of gastric antrum and gastric angle has no statistical significance(P>0.05).Comparison of H.pylori colonization density among different atrophy degree in the verrucous lesions of gastric antrum and gastric angle has no statistical significance(P>0.05).In the verrucous lesions of gastric antrum,the comparison of the H.pylori colonization density has no statistical significance between the active gastritis or not(P>0.05).But in the gastric angle,the H.pylori colonization density is significantly higher in the reactive gastritis than that in the non-active gastritis(P<0.05).3 Comparison of P53 and Lgr5 among different pathological,H.pylori colonization density in the verrucous lesions of gastric antrum and gastric angleThe comparison of P53 among different inflammation degree,atrophy and intestinal metaplasia shows no statistical significance both in the verrucous lesions of gastric antrum and gastric angle(P>0.05),but there exists significant difference in different H.pylori colonization density.The positive group is significantly greater than the negative(P<0.05),but no significant difference among different positive groups(P>0.05).In gastric angle,the level of P53 in the active gastritis was obviously higher than that in the without activity gastritis(P<0.05),but no difference in the verrucous lesions of gastric antrum(P>0.05).The comparison of Lgr5 among different H.pylori colonization density,inflammation degree and intestinal metaplasia shows no statistical significance both in the verrucous lesions of gastric antrum and gastric angle(P>0.05),but there exists significant difference in different atrophy degree.When exists atrophy,the level of Lgr5 is significantly greater than that in non-atrophic gastritis(P<0.05).Conclusions:1 In the verrucous gastritis patients,H.pylori colonization density in the verrucous lesions of gastric antrum is higher than that in the relatively normal gastric angle.2 In the verrucous gastritis patients,the relatively normal gastric angle is more likely to be atrophy compared with the verrucous lesions of gastric antrum,maybe the best biopsy site to evaluate the degree of atrophy.3 The level of P53 protein is higher in the verrucous lesions of gastric antrum than that in the relatively normal gastric angle,and there is no relationship in different degree of inflammation,atrophy,intestinal metaplasia,or H.pylori colonization density,but the existence of H.pylori.4 There is no difference between the verrucous lesions of gastric antrum and relatively normal gastric angle about the level of Lgr5 protein,there is no relationship in different degree of inflammation,intestinal metaplasia,or H.pylori colonization density,but the existence of atrophy. |
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