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胃肠上皮化生中的黏膜屏障缺陷:采用共聚焦显微的体内评价

发布日期:2014-1-29 12:40:39 文章来源:GIE 作者次数:1191

    胃肠上皮化生中的黏膜屏障缺陷:采用共聚焦显微的体内评价

    背景

    幽门螺旋杆菌感染和肠上皮化生(IM)与胃癌有关。胃黏膜屏障受损可与该致癌作用有关。

    目的

    评估IM患者黏膜屏障缺陷的体内功能性成像的激光共聚焦激光显微内镜CLE)。

    设计

    本研究为前瞻性对照研究。

    环境

    一所三级医疗学术中心。

    患者

    本研究纳入胃黏膜IM患者,这些患者接受过CLE监测。

    干预

    采用CLE识别特定的IM黏膜和非IM黏膜,采集定向活检样品,进行病理组织学和电子显微镜检查。

    主要测定结果

    通过电子显微镜制定和证实细胞旁路荧光素渗漏的CLE后评估。我们也评估了根除幽门螺旋杆菌对黏膜屏障的影响。

    结果

    42例患者参与了本研究。在非IM样品中,与幽门螺旋杆菌阴性对照组相比,幽门螺旋杆菌阳性样品中的细胞旁路通透性增加更显著,分别为54 ± 31% 3 ± 6%P <0 .05。在IM样品中,幽门螺旋杆菌阴性与阳性两组的通透性均显著增加,分别为67 ± 34%72 ± 28% 3 ± 6%,二者P < 0.05CLE后评估结果与电子显微镜检查结果有着良好的相关性(R2 0.834, P < 0.0001)。如电子显微镜和CLE检查所显示,根除幽门螺旋杆菌后,IM黏膜的细胞旁路屏障功能障碍得到显著改善(二者P < 0.001)。然而,IM黏膜中无显著变化。

    局限性

    单中心研究。

    结论

    CLE允许黏膜屏障缺陷的功能性成像。不管幽门螺旋杆菌是否根除,胃肠上皮化生与细胞旁路屏障损伤均有关。

    缩写词CLE,共聚焦激光显微内镜;IM,肠上皮化生。

     


     

    Mucosal barrier defects in gastric intestinal metaplasia: in vivo evaluation by confocal endomicroscopy

    Background

    Helicobacter pylori infection and intestinal metaplasia (IM) are associated with gastric cancer. An impaired gastric mucosal barrier could be involved in this carcinogenesis.

    Objective

    To evaluate laser confocal laser endomicroscopy (CLE) for in vivo functional imaging of mucosal barrier defects in patients with IM.

    Design

    Prospective, controlled study.

    Setting

    A tertiary-care academic center.

    Patients

    This study involved patients with IM of the gastric mucosa who underwent CLE for surveillance.

    Interventions

    Specific IM mucosa and non-IM mucosa in patients were identified by CLE, and targeted biopsy samples were taken for histopathology and electron microscopy.

    Main Outcome Measurements

    Post-CLE assessment of paracellular fluorescein leakage was devised and validated by electron microscopy. We also evaluated the effect of H pylori eradication on the mucosal barrier.

    Results

    Forty-two patients were included. Of non-IM samples, the paracellular permeability was significantly increased in H pylori–positive samples compared with H pylori–negative controls (54 ± 31% vs 3 ± 6%, P < .05). Of IM samples, the permeability was significantly increased in both H pylori–negative and H pylori–positive samples (67 ± 34% and 72 ± 28% vs 3 ± 6%, both P < .05). The results of post-CLE assessment correlated well with the electron microscopy findings (R2 0.834, P < .0001). After the eradication of H pylori, the paracellular barrier dysfunction of non-IM mucosa was significantly improved as shown by electron microscopy and CLE (both P < .001). However, there was no significant change in IM mucosa.

    Limitations

    Single-center study.

    Conclusions

    CLE allows functional imaging of mucosal barrier defects. Gastric IM is associated with an impaired paracellular barrier irrespective of H pylori eradication.

    Abbreviations:  CLE, confocal laser endomicroscopy, IM, intestinal metaplasia

     

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