Діагностика диспластичних змін епітелію слизової оболонки шлунка за допомогою гістологічного та імуногістохімічного методів у хворих на хронічну виразку шлунка

Abstract

Діагностика, яка проведена за допомогою гістологічного методу з виявленням мітотичного режиму та імуногістохімічного маркеру Кі-67 (клон МІВ-1) показала зміни епітелію слизової оболонки шлунка характерні для дисплазії різного ступеня в слизовій оболонці шлунка у пацієнтів, які хворіють на хронічну виразку шлунка. Експансія маркеру Кі-67 у випадках з указаними дисплазіями свідчить про високу проліфера- тивну активність в осередку дисплазії епітелію ямок та проліферацію клітин інфільтрата в стромі, характерну для кожної з груп дисплазій. Існує дуже сильний кореляційний зв’язок між ступенем дисплазії, що виявлена за допомогою гістологічного методу і маркеру Кі-67. Коефіцієнт кореляції Пірсона СКЛАВ 0,931. Загальний результат свідчить про існування статистично достовірної залежності з ймовірністю 0,99; Диагностика, которая проведена при помощи гистологического метода с определением митотического режима и иммуногистохимического маркера Кі-67 (клон МІВ-1) показала изменения эпителия слизистой оболочки желудка характерные для дисплазии разной степени в слизистой оболочке желудка у пациентов, которые болеют хронической язвой желудка. Экспансия маркера Кі-67 в случаях с указанными дисплазиями свидетельствует о высокой пролиферативной активности в участках дисплазии эпителия ямок и пролиферации клеток инфильтрата в строме, характерной для каждой из групп дисплазии. Существует очень сильная кореляционная связь между степенью дисплазии, выявленой при помощи гистологического метода и маркера Кі-67. Коэфициент кореляции Пирсона rxy составил 0,931. Общий результат свидетельствует о существовании статистически достоверной зависимости с вероятностью 0,99; The highest rate of mitotic index (22,3±1,7%) has been detected in patients with chronic gastric ulcer in the area around the ulcer (AU). In the pyloric (P) part (20,0±2,8%) and the lesser curvature (LC) (19,8±2,3%) this rate was lower, but no significant difference has been detected. The lowest rate of mitotic index has been detected in the body (B) of stomach (14,3±4,5%), which is significantly lower р<0,01 than in other parts of the stomach. As regards the number of mitosis at metaphase, the index around the ulcer (37,3 ± 7,8%) was lower than in the pyloric part (46,9 ± 2,8%) and in lesser curvature (44,9 ± 2,8%). Number of mitosis at metaphase was significantly lower (р<0,01) in the body of stomach (20,6±8,3%) than around the ulcer, in pyloric part and lesser curvature, i. e., 37,3±7,8%, 46,9±2,8% and 44,9±2,8%, respectively. Similarly, the rate of pathological mitoses tended to be reduced, which was significantly lower (р<0,01) in the body of stomach (3,8±2,5%) as compared with the area around the ulcer (10,6±1,3%), in pyloric part (15,6±1,9%) and lesser curvature (13,7±1,9%). High proliferative activity is confirmed by the Кі-67 marker; marker index is > 30,0%. Diagnostics, made by the histological method, specifying the mitotic regimen, and by immunohistochemical Кі-67 marker (MIB-1clone) showed changes in gastric mucosa epithelium, specific to gastric mucosa epithelium dysplasia of various severity in patients, suffering from chronic gastric ulcer. In cases of indicated dysplasia the Кі-67 marker expression is the evidence of high proliferative activity in the areas of recesses epithelium dysplasia and proliferation of infiltrate cells in stroma, which is specific to each group of dysplasia. Findings of correlation analysis between the degree of mucosa epithelium dysplasia, made by the histological method and Кі-67 marker indices of gastric mucosa samples showed that the Pearson’s correlation coefficient, rxy, constituted 0,931, which makes it possible to conclude about the existence of very strong relationship. Coefficient of determination, D=rxy*2, constituted 0,866. Critical value of correlation coefficient with probability of 0, 95 corresponded to 0, 2732. Critical value of correlation coefficient with probability of 0, 99 corresponded to 0, 3511. The comparison of correlation coefficient, rxy, with critical (tabulated) value, rcr, worth of 0, 95, corresponded to rxy>rcr The comparison of correlation coefficient, rxy, with critical (tabulated) value, rcr worth of 0, 99, corresponded to r >r Covariation coefficient constituted 522,914, which makes it possible to conclude about staxy cr. tistically significant dependence between the indices with probability of 0, 99. Between the indices of mitotic regimen of gastric mucosa, i. e., mitotic index, number of mitoses at metaphase, number of pathological mitoses, and degree of dysplasia of gastric mucosa epithelium in patients with chronic gastric ulcer, the Pearson’s correlation coefficient, rxy, constituted 0,197, 0,607 and 0,881, respectively, corresponding to weak, moderate and strong relationship. Coefficient of determination, D=rxy*2, constituted 0,039, 0,369 and 0,776, respectively. Critical value of correlation coefficient with probability of 0,95 constituted 0, 2732. Critical value of correlation coefficient with probability of 0,99 constituted 0,3511. The comparison of correlation coefficient, rxy, with critical (tabulated) value, rcr, worth of 0, 95, corresponded to r <r and r >r , respectively. Critical value of correlation coefficient with probability of 0,99 xy cr xy cr corresponded to r <r and r >r , respectively. Covariation coefficient constituted 0,389, 3,442 and 0,859, respecxy cr xy cr tively, which concluded that no correlation has been detected between the mitotic index and degree of dysplasia of gastric mucosa epithelium; however, statistically significant dependence with probability of 0,99 has been detected between the rates of mitoses at metaphase, pathological mitoses and index of gastric mucosa epithelium dysplasia. Indices of mitotic regimen tend to be increased in the following direction: B^ AU ^LC^P Between the indices of mitotic regimen of gastric mucosa and degree of manifestation of dysplasia of gastric mucosa epithelium in patients with chronic gastric ulcer, the Pearson’s correlation coefficient, rxy, constituted 0,197, 0,607 and 0,881, respectively, corresponded to weak, moderate and strong relationship. Between the degree of dysplasia, judging by the indices, obtained by the histological method and Кі-67 marker indices of gastric mucosa samples, the Pearson’s correlation coefficient, rxy, constituted 0,931, identifying the existence of very strong relationship. The Кі-67 marker expression correlates with indices of dysplasia, obtained by the histological method, showing that it is informative in detecting proliferative activity of gastric mucosa. The abovementioned concludes that there is very strong correlation between the degree of dysplasia, detected by the histological method and Кі-67 marker. The Pearson’s correlation coefficient, rxy, constituted 0,931. The overall result shows statistically significant dependence with probability of 0, 99.