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目的:通过检测BRCA1蛋白在大肠黏膜微细结构改变中的表达,探讨BRCA1蛋白在不同大肠黏膜病变腺管开口分型中表达的临床意义。方法:根据Kudo分型方法,染色放大内镜下大肠黏膜病变腺管开口分为Ⅰ～Ⅴ型;其中Ⅰ～Ⅱ型为非肿瘤性病变,ⅢL～Ⅳ型为腺瘤,Ⅴ型为癌性病变,所有病变诊断结果均由病理学证实。应用免疫组化方法检测活检组织BRCA1蛋白的表达。结果:染色放大内镜下检出Ⅰ～Ⅴ型息肉样病变256枚,其中非肿瘤性病变(73例),肿瘤性病变(183例);随着大肠腺管分型序数的递增,BRCA1蛋白的阳性表达率逐渐增加,各腺管分型之间的差异具有统计学意义(P<0.000 1);癌性病变BRCA1蛋白的阳性率明显高于腺瘤性病变和非肿瘤性病变(P<0.000 1)。结论:随着大肠腺管分型序数的递增,BRCA1蛋白的阳性率逐渐增加,尤其在内镜诊断的大肠癌性病变中有着较高的表达率。因此,染色放大内镜下观察大肠黏膜微细结构改变的同时联合检测BRCA1蛋白的表达有助于大肠癌的早期发现。
Objective: To investigate the clinical significance of BRCA1 protein expression in the colorectal mucosa of different colorectal mucosa lesions by detecting the expression of BRCA1 protein in the changes of mucosal microfold structure. Methods: According to the Kudo classification method, the enlarged gland endoscopic mucosal lesion of the glandular duct opening was divided into Ⅰ ~ Ⅴ type; Ⅰ ~ Ⅱ type of non-neoplastic lesions, Ⅲ L ~ Ⅳ type of adenoma, Ⅴ type of cancer Lesions and all lesions were confirmed by pathology. Immunohistochemistry was used to detect the expression of BRCA1 protein in biopsies. Results: There were 256 type Ⅰ ~ Ⅴ polyp lesions under the magnifying endoscopy, including 73 non - neoplastic lesions and 183 neoplastic lesions. With the increase of the colorectal mutilation number, the expression of BRCA1 protein (P <0.000 1). The positive rate of BRCA1 protein in cancerous lesions was significantly higher than that in adenomatous lesions and non-neoplastic lesions (P < 0.000 1). CONCLUSION: The positive rate of BRCA1 protein gradually increases with the increase of colorectal adenocarcinoma typing sequence, especially in colon cancer with endoscopic diagnosis. Therefore, it is helpful for the early detection of colorectal cancer that the combined detection of the expression of BRCA1 protein while observing the changes of the fine structure of the colorectal mucosa under the magnifying endoscopy.