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Expression and its clinical significance of G-protein coupled receptor 49 in pancreatic carcinoma

Xinxin TIAN ; Rui LI ; Min TAO ; Songguang JU

Chinese Journal of Digestion.2017;37(5):326-330. doi:10.3760/cma.j.issn.0254-1432.2017.05.009

Objective To investigate the clinical significance and biological role of G-protein coupled receptor 49(GPR49) expression in pancreatic carcinoma.Methods GPR49 expression in tumor and adjacent normal tissues of 77 patients with pancreatic cancer was compared by tissue microarray and immunohistochemistry.And then, the GPR49 expression levels in the tumor tissues of patients with different pathological grades and clinical stages were analyzed.GPR49 positive pancreatic cancer cell line CFPAC-1 was taken as cellular model.CFPAC-1 cells were stimulated with roof plate-specific spondin(RSPO)1, the ligand of GPR49, in vitro.The effect of RSPO1 on CFPAC-1 cells proliferation was evaluated with cell counting.The effect of RSPO1 on the expression of membrane molecular CD44 in CFPAC-1 cells was detected by flow cytometry.CFPAC-1 cells incubated with RSPO1 were subcutaneously implanted into nude mice.And then, the time of tumor formation and tumor size were observed.T test and single factor analysis of variance were performed for statistical analysis.Results GPR49 was widely expressed in all 77 pancreatic cancer tissues.By immunohistochemistry, the score of GPR49 expression in pancreatic cancer tissues was 9.0±2.4, which was higher than that of adjacent normal tissues (5.7±2.4), and the difference was statistically significant (t=8.995, P<0.01).There was no correlation between GPR49 expression and tumor sizes, pathological grades, lymph node metastasis, and clinical stages (all P>0.05).The results of experiments in vitro indicated that RSPO1 could promote CFPAC-1 cells proliferation and up-regulate CD44 expression in CFPAC-1 cells.Experiments in vivo demonstrated that after 30 days the tumor volume of mice implanted with RSPO1-pretreated CFPAC-1 cells was (606.0±188.0) mm3, which was larger than that of PBS-pretreated group ((364.2±83.7) mm3), and the difference was statistically significant (t=2.616, P=0.031).Conclusion GPR49 is widely expressed in pancreatic cancer cells and RSPO1/GPR49 pathway has play a role in promoting the proliferation of pancreatic cancer cells, which might be a potential target for interfering pancreatic cancer.

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Mechanism of microRNA150 in regulating invasion and metastasis of gastric cancer by targeting Ras-interacting protein 1

Yin NI ; Jinli ZHANG ; Renhua SUN

Chinese Journal of Digestion.2017;37(5):319-325. doi:10.3760/cma.j.issn.0254-1432.2017.05.008

Objective To investigate the effects and mechanism of microRNA150 (miRNA150) on proliferation, invasion and metastasis of gastric cancer.Methods From January 2015 to June 2016, 45 surgical specimens were collected.The expression of miRNA150 and Ras-interacting protein 1(RASIP1) at miRNA level in gastric cancer tissues and paracancerous tissues were quantified by quantitative real-time fluorescent reverse transcriptase-polymerase chain reaction (qRT-PCR).The correlation between miRNA150 and the biological features of gastric cancer as well as RASIP1 expression was analyzed.Gastric cancer cell line SGC-7901 was cultured and transfected with pcDNA3.1-miRNA150 expression plasmids.The effect of miRNA150 over-expression on the proliferation of SGC-7901 cells was determined by 3-(4,5-dimethyl-2-thiazolyl)-2,5-dipheayl 2-H-tetrazolium bromide (MTT) assay.And the effect of miRNA150 over-expression on the invasion and metastasis of SGC-7901 cells was detected by Transwell assay.The potential target gene of miRNA150 was analyzed by bioinformatics software and dual-luciferase reporter assay system.The effect of miRNA150 over-expression on RASIP1 expression in SGC-7901 cells was tested by qRT-PCR and Western blotting.Analysis of variance and t test were used to compare normal distribution data.And the Mann-Whitney rank sum test was used to compare skewed distribution data.Spearman assay was used for correlation analysis.Results The median level of miRNA150 in gastric cancer tissue was higher than that of paracancerous tissues (3.85, 0.26 to 7.92 vs 1.98, 0.19 to 5.66), and the difference was statistically significant (U=466.22,P<0.05).The median level of RASIP1 mRNA in gastric cancer tissue (1.65, 0.13 to 3.59) was lower than that of paracancerous tissues (2.96, 0.59 to 6.08), and the difference was statistically significant (U=522.31,P<0.05).The results of correlation analysis indicated that RASIP1 expression level was negatively correlated with miRNA150 expression (r=-0.589, P=0.008).The RASIP1 expression at mRNA level was negatively correlated with miRNA150 expression (r=-0.614, P=0.004).The dual-luciferase reporter assay showed RASIP1 was the target gene of miRNA150.The miRNA150 expression level was related with tumor size, TNM staging and lymph node metastasis(χ2=5.81, 6.00 and 10.04,all P<0.05).The results of MTT assay showed that after SGC-7901 cells cultured for 24 hours, the A value of pcDNA3.1-miRNA150 plasmid transfected cells was higher than that of the untransfected SGC-7901 cells (0.51±0.04 vs 0.79±0.03), and the difference was statistically significant (t=4.745, P<0.05).The results of Transwell assay indicated that there were more invasive and metastatic cells in pcDNA3.1-miRNA150 plasmid transfected cells.The results of qRT-PCR showed that the relative levels of RASIP1 mRNA in control group, pcDNA3.1-miRNA150 plasmid transfected cells and pcDNA3.1 empty plasmid transfected cells were 1.00±0.02, 0.51±0.03 and 1.08±0.03, respectively.The RASIP1 mRNA level in pcDNA3.1-miRNA150 plasmid transfected cells was lower than untransfected and pcDNA3.1 empty plasmid transfected cells, and the differences were statistically significant (t=3.940, 4.120, both P<0.05).miRNA150 could negtively regulate the RASIP1 protein expression and promote the proliferation and invasion of gastric cacer cells.Conclusions Over-expression of miRNA150 induced invasion and metastasis of gastric cancer by down-regulating RASIP1 expression.miRNA150 may be a novel biomarker for the diagnosis and treatment of tumor metastasis.

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Expression of stomach cancer-associated transcript 16 in gastric cancer tissues and its effects on gastric cancer biological behavior

Jianfeng ZHANG ; Qianfeng ZHANG ; Xiaoling KUAI ; Zhongshang SUN ; Zhenbiao MAO

Chinese Journal of Digestion.2017;37(5):313-318. doi:10.3760/cma.j.issn.0254-1432.2017.05.007

Objective To study the expression of long non-coding RNA (LncRNA) stomach cancer-associated transcript 16 (STCAT16) in gastric cancer tissues and its effects on the proliferation, migration and invasion of gastric cancer cells.Methods The different expression of STCAT16 in 32 cases of gastric carcinoma and corresponding adjacent tissues was detected by real-time fluorescence quantitative polymerase chain reaction (PCR).The STCAT16 overexpression plasmid and empty vector was separately transfected gastric cancer cell line AGS with low expression of STCAT16.The cell proliferation of empty vector group, non-transfection group and STCAT16 analogue transfection group was evaluated by cell counting kit-8 (CCK-8) assay at 0, 24, 48, 72 and 96 hours after transfection.The colony forming ability was tested by colony formation assay.The cell invasion ability was measured by Transwell chamber assay and migration ability was tested by scratch-wound assay.The effects of STCAT16 on tumorigenicity in vivo were verified by tumorigenicity experiments in nude mice.T-test and one-way analysis of variance were performed for data analysis.Repeated measures analysis of variance was used to compare the repeated measured data among groups.Chi square test and Fisher exact probability method were used for comparison of counting data.Results The expression of STCAT16 in gastric cancer tissues was low (0.87±0.19), while it was high in corresponding adjacent tissues (2.32±0.37), and the difference was statistically significant (t=-20.859, P<0.05).The expression of STCAT16 of STCAT16 analogue transfection group was higher than that of empty vector group (3.43±0.25 vs 1.00±0.06), and the difference was statistically significant (t=-16.795,P<0.05).Compared to empty vector group and non-transfection group, the cell proliferation decreased in STCAT16 analogue transfection group at 72 and 96 hours after transfection (1.41±0.07, 1.42±0.08, 1.03±0.09, and 1.72±0.11, 1.78±0.14, 1.24±0.08, respectively), and the differences were statistically significant (t=15.043,5.358, 12.193 and 8.109, all P<0.05).The results of colony formation assay indicated that the colony forming ability of gastric cells in STCAT16 analogue transfection group was lower than that in empty vector group (97.3±9.1 vs 185.0±20.1) and non-transfection group (97.3±9.1 vs 138.0±11.1), and the differences were statistically significant (t=11.634 and 4.417,both P<0.05).The results of Transwell assay showed that the number of AGS cells passing through the membrane of STCAT16 analogue transfection group was significantly less than those of empty vector group and non-transfection group (151.0±28.1 vs 228.0±38.2 and 151.0±28.1 vs 199.3±17.9), and the differences were statistically significant (t=4.823 and 4.747,both P<0.05).After transfection for 48 hours and 72 hours, the scratch-wound repair rate of STCAT16 analogue transfection group decreased, compared with those of empty vector group and non-transfection group ((52.67±6.11)%, (53.33±5.51)%, (42.67±4.72)%, and (90.67±2.51)%, (90.60±5.41)%, (69.67±1.52)%, respectively), and the differences were statistically significant (t=5.773, 5.955, 21.000 and 5.881, all P<0.05).The results of tumorigenicity in nude mice showed that compared with those of empty vector group, the tumor size of STCAT16 analogue transfection group was smaller at one-, two-, three-and four-week ((0.42±0.10) cm3 vs (0.16±0.05) cm3, (0.66±0.13) cm3 vs (0.34±0.05) cm3, (1.25±0.22) cm3 vs (0.54±0.13) cm3, (2.54±0.46) cm3 vs (0.78±0.41) cm3)), and the differences were statistically significant (t=3.175, 4.190, 7.996 and 9.705, all P<0.05).Conclusions STCAT16 is lowly expressed in gastric cancer tissues.The proliferation, migration, invasion ability and tumorigenicity in nude mice of gastric cancer cell is inhibited after upregulating the expression of STCAT16.

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Diagnosis of autoimmune pancreatitis with computed tomography

Hongyuan SHI ; Xuesong ZHAO ; Jiayi YAN ; Qing XU ; Xisheng LIU ; Haibin SHI ; Fei MIAO

Chinese Journal of Digestion.2017;37(5):303-307. doi:10.3760/cma.j.issn.0254-1432.2017.05.005

Objective To investigate the computed tomography (CT) features of autoimmune pancreatitis (AIP).Methods The CT imaging data of 33 patients with AIP confirmed by pathology and/or steroid therapy were retrospectively analyzed.Image analysis including the shape of pancreas, density of lesion, contrast enhancement, the changes of pancreatic duct and biliary duct, peripancreatic appearances and adjacent organ involvement.T test was performed for statistical analysis.Results Among 33 patients with AIP, 23 cases (70%) with pancreatic parenchyma diffuse enlargement, eight cases (24%) with partial enlargement and two cases (6%) with normal pancreas.The lesions appeared hypoattenuating or isoattenuating on plain CT scan.After contrast-enhanced scan, the average CT values of lesions were (75.7±17.0) Hu at arterial phase, which was lower than that of venous phase (90.7±12.0) Hu, and the difference was statistically significant (t=3.378,P=0.002).The lesions demonstrated as progressive enhancement at venous phase.Among 33 patients, the main pancreatic duct was visible in six patients (18%).Sixteen patients (48%) presented with intrahepatic and extrahepatic biliary tract dilatation caused by intrapancreatic common bile duct stenosis.Thickened envelope-like structure around the lesions, presenting as capsule sign was seen in 14 patients (42%).Extra-pancreatic organ involvement was found in seven patients including three cases of kidney involvement.After treated with steroid, seven patients repeated CT which showed different degrees of improvement.Conclusion The main CT findings of AIP are diffuse and partial enlargement of pancreas with progressive enhancement at venous phase, envelope-like structure around pancreas, and stenosis of intrapancreatic common bile duct, which are important in the diagnosis and differential diagnosis of AIP.

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Preoperative diagnosis of pancreatic neuroendocrine neoplasms with computed tomography and magnetic resonance imaging

Xiaozhu LIN ; Huanhuan XIE ; Qingrou WANG ; Weimin CHAI ; Nan CHEN ; Fei MIAO ; Kemin CHEN ; Fuhua YAN

Chinese Journal of Digestion.2017;37(5):308-312. doi:10.3760/cma.j.issn.0254-1432.2017.05.006

Objective To assess the value of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of pancreatic neuroendocrine neoplasms (PNEN) and to analyze the factors influencing thepreoperative imaging diagnosis of PNEN.Methods From January 2016 to November 2016, patients with PNEN diagnosed by surgery and biopsy were collected. CT and MRI data of them were analyzed. The CT values or signal intensity of the lesions and the pancreatic parenchyma were measured and the contrast-to-noise ratio (CNR) of the lesion was calculated. Detecting sensitivity and diagnosis accuracy of CT and MRI were compared. Detecting sensitivity of different MRI sequences was also analyzed. Diagnosis accuracy of non-functional PNEN and functional PNEN was compared and analyzed. Lesion CNR was compared between arterial phase and portal venous phase of the contrast enhanced CT. The sensitivity, accuracy and constituent ratio were compared by nonparametric analysis. Independent sample t test and one-way analysis of variancewere performed for the quantitative parameters comparison. Results A total of 54 patients with 56 lesions of PNEN were included for two of whom had two lesions each. CT and MRI were both performed in 44 patients (46 lesions).Detecting sensitivity and diagnosis accuracy of CT were 97.8% (45/46) and87.0% (40/46), respectively. Detecting sensitivity of MRI were 97.8% (45/46) and89.1% (41/46), respectively. There was no significant difference in detecting sensitivity and diagnosis accuracy between CT and MRI (both P>0.05). The CNR of lesion in arterial phase was higher than that of portal venous phase(4.7±3.8 vs 3.4±2.5), and the difference was statistically significant (t=2.949, P<0.05). Detecting rates of T1 weighted imaging with fat suppression (T1WI-FS) image, T2 weighted imaging with fat suppression (T2WI-FS) image, diffusion weighted imagingand dynamic contrast enhanced T1WI-FS image were 90.0% (45/50), 88.0%(44/50), 86.0%(43/50), and 91.7% (44/48), respectively. There was no significant difference in detecting rate among these images sequences (Q=2.526, P=0.510). Tumor diameter in non-functional PNEN was significantly larger than that in functional PNEN ((2.9±1.6) cm vs (1.7±0.7) cm)(t=3.479,P<0.05). The overall diagnosis rate of non-functional PNEN with CT and MRI before operation was 70.8% (17/24), which was significantly lower than that of functional PNEN (100.0%, 31/31) (χ2=10.360，P=0.002).Conclusions CT and MRI are both sensitive in detectingPNEN, and they were two complementary modalities. CT image in arterial phase delineated the lesion better than that in portal venous phase. MRI images with different sequences can becomplementary and there is no significant difference in detecting sensitivity for PNEN among different sequences. CT and MRI play an equal rolein the diagnosis of PNEN before operation. Because of atypical CT and MRI findings, the diagnosis of non-functional PNEN is more difficult thanfunctional PNEN.

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Diagnostic value of endoscopic ultrasound guided fine needle aspiration combined with the new category of papanicolaou society of cytopathology in solid pancreatic lesions

Qiao YE ; Ke CHEN ; Qianqian LIU ; Liu YU ; Shubei WANG ; Ying XU ; Tingjun YE ; Yunwei SUN

Chinese Journal of Digestion.2017;37(12):823-827. doi:10.3760/cma.j.issn.0254-1432.2017.12.007

Objective To study the diagnostic value of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) combined with the new category of papanicolaou society of cytopathology in solid pancreatic lesions (SPL) rapid on-site evaluation (ROSE).Methods From February 2011 to October 2014,225 patients with SPL who underwent EUS-FNA and obtained the cytological diagnosis were enrolled.The lesions were finally diagnosed according to pathological results,imaging and follow-up data,and then the sensitivity,specificity,and accuracy of EUS-FNA in the diagnosis of SPL were calculated based on the new papanicolaou society of cytopathology terminology.Logistic stepwise regression analysis was performed to analyze the risk factors.Results Among 225 patients with SPL,96 cases (42.7％)had uncertain cytological diagnosis,17.3％ (39/225) could not be diagnosed,8.0％ (18/225) were atypical lesions,and 17.3％ (39/225) were suspicious malignant carcinomas.Among 129 cases (57.3％)with certain cytological diagnosis,15.1％ (34/225) were benign lesions,14.7％ (33/225) were tumors (benign or others) and 27.6％ (62/225) were malignant tumors.When atypical lesions were added into non-tumor lesions or tumor lesions,the sensitivity,specificity and accuracy of diagnosis were 87.3 ％,91.7％,88.2％,and 94.7％,72.2％,90.3％,respectively.Serum CA125≥14 kU/L (odds ratio (OR) =7.13,95％ confidence interval (CI) 2.02 to 25.22,P=0.002) and history of biliary disease (OR=3.85,95％CI 1.22 to 12.51,P=0.022) were two independent risk factors of pancreatic tumors.Conclusions Despite of a high percentage of uncertain cytological diagnosis,EUS-FNA still has high diagnostic value in SPL when combined with the new papanicolaou society of cytopathology terminology.Furthermore,serum CA125≥14 kU/L and history of biliary disease may help to diagnose pancreatic tumors.

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Comparison of the gastric residual volume between conventional single-dose and split-dose bowel preparation before colonoscopy under general anesthesia

Chunsheng CHENG ; Shigui XUE ; Houde ZHANG ; Weiguo DONG

Chinese Journal of Digestion.2017;37(12):812-815. doi:10.3760/cma.j.issn.0254-1432.2017.12.005

Objective To explore the difference in gastric residual volume (GRV) between singledose and split-dose bowel preparation before colonoscopy under general anesthesia.Methods From October 8th to December 30th in 2016,the out-patients undergoing gastroscopy and colonoscopy with anesthesia services on the same day were selected and divided into the traditional single-dose bowel preparation group and split-dose bowel preparation group.The GRV and intestinal preparation quality were compared between the two groups.T test was used for statistical analysis and multiple linear regression analysis was performed for the influence factors of GRV analysis.Results A total of 121 patients were enrolled,60 patients in the spilt-dose bowel preparation group and 61 in the traditional single-dose bowel preparation group.The mean GRV of the split-dose bowel preparation group was (17.3 ± 12.2) mL,which was lower than that of the single-dose bowel preparation group ((23.7 ± 14.6) mL),and the difference was statistically significant (t =2.642,P=0.009).The score of intestinal preparation quality of the split-dose bowel preparation group was 8.05 ± 0.85,which was higher than that of the single-dose bowel preparation group (7.67±1.19),and the difference was statistically significant (t =-2.002,P=0.048).Fasting time was related with GRV (odd ratios (OR)=1.732,95％ contidence interval (CI) O.299 to 3.168,P=0.018).Conclusion The GRV of patients with split-dose bowel preparation before colonoscopy is lower than that of traditional single-dose bowel preparation,thus reducing the risk of aspiration during anesthesia.

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Value of antibiotic prophylaxis after endoscopic retrograde cholangio-pancreatography

Pingping XU ; Chunyan ZENG ; Shunhua LONG ; Guihai GUO ; Zhijian LIU ; Guohua LI ; Youxiang CHEN

Chinese Journal of Digestion.2017;37(12):828-832. doi:10.3760/cma.j.issn.0254-1432.2017.12.008

Objective To investigate the effects of antibiotic prophylaxis on post-operation complications after endoscopic retrograde cholangio-pancreatography (ERCP).Methods From January 1st,2011 to December 31st,2013,1 951 patients undergoing ERCP were enrolled and divided into postoperative antibiotic prophylaxis group (antibiotics group,630 cases) and postoperative non-antibiotic treatment group (non-antibiotics group,1 321 cases).Complications after ERCP were compared between the two groups.Chi square test,single factor analysis and multiple factor analysis were performed for statistical analysis.Results Among the 1 951 patients,277 patients had postoperative complications:101 patients (5.18％) with post-endoscopic retrograde cholangio-pancreatography pancreatitis (PEP),54 patients (2.77％) with hyperamylasemia,134 patients (6.87％) with biliary infection,eight patients (0.41％) with hemorrhage,one patient (0.05％) with intestinal obstruction and one patient (0.05％) with perforation.The incidence of postoperative biliary infection of antibiotics group was 4.44％ (28/630),which was lower than that of non-antibiotics group (8.02％,106/1 321),and the difference was statistically significant (x2 =8.546,P =0.030).The incidences of PEP of antibiotics group and nonantibiotics group were 4.92％ (31/630) and 5.30％ (70/1 321),respectively.The incidences of postoperative hyperamylasemia of antibiotics group and non-antibiotics group were 3.02％oo (19/630) and 2.65％ (35/1 321),respectively.The incidences of upper gastrointestinal hemorrhage were 3.02％ (19/630) and 2.65％ (35/1 321),respectively.The incidences of intestinal obstruction were 0 (0/630) and 0.08％ (1/1 321),respectively,while the incidences of perforation post-operation were 0.16％ (1/630) and 0 (0/1 321),respectively,and the differences were not statistically significant (all P＞0.05).Cholangiocarcinoma (odd ratios (OR)=2.93,95％ confidence interval (CI) 1.88 to 4.56,P＜0.01) and repeated ERCP during hospitalization (OR=2.53,95 ％ CI 1.63 to 3.93,P＜0.01) were the independent risk factors of cholangitis after operation.However,endoscopic sphincterotomy (OR=0.65,95 ％ CI 0.44 to 0.97,P =0.030) and antibiotics prophylaxis (OR =0.64,95％ CI 0.39 to 0.95,P =0.030) were the protective factors.Conclusions Antibiotic prophylaxis after ERCP can reduce the occurrence of postoperative cholangitis.Paitents with cholangiocarcinoma,repeated ERCP procedures during hospitalization or without endoscopic sphincterotomy should be recommended for antibiotic prophylaxis.

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Expressions of serum 25 (OH)D, vitamin D receptor and vitamin Dl-α hydroxylase in intestinal mucosa tissues of patients with inflammatory bowel disease

Jianping HUANG ; Tao CHEN ; Yi LIU ; Liyuan LYU ; Xiang LI ; Wenjie YUE ; Jie LIU

Chinese Journal of Digestion.2017;37(12):816-822. doi:10.3760/cma.j.issn.0254-1432.2017.12.006

Objective To investigate the expression of serum 25(OH)D,vitamin D receptor (VDR)and vitamin D1-α hydroxylase (CYP27B1) in intestinal mucosa tissues of patients with inflammatory bowel disease (IBD).Methods From January 1st to December 31st in 2014,105 patients with IBD were enrolled,among them there were 49 cases of ulcerative colitis (UC) and 56 cases of Crohn's disease (CD);there were 20 cases in remission,26 cases in mild active phase,37 cases in moderate active phase and 22 cases in severe active phase;and 50 cases with lesions located in the left colon and 55 cases with lesions located in the right colon.At the same period,45 healthy individuals were also recruited as controls,whom were suspected as IBD but at last proved healthy.The lactulose and mannitol absorption ratio (LMR),serum endotoxin,tumor necrosis factor-α (TNF-α) and 25(OH)D levels,and the expressions of VDR and CYP27B1 in the intestinal mucosa tissues were detected in all the subjects.T test,one-way analysis of variance and chi square test were used for statistical analysis.Results The LMR,endotoxin and TNF-α levels of UC group were (63.2 ± 13.9)％,(118.9 ± 19.7) EU/mL,and (109.6 ± 18.4) ng/L,respectively,which were higher than those of the healthy control group ((3.3 ± 1.2)％,(34.2 ±5.6) EU/mL,and (0.6±0.3) ng/L);the level of 25 (OH)D was (36.6± 9.7) nmol/L,which was lower than that of healthy control group ((49.6± 10.9) nmol/L),and all the differences were statistically significant (t =28.796,29.284,27.817 and 6.118,all P＜0.05).LMR,endotoxin and TNF-α levels of CD group were (52.9±11.3)％,(96.4±10.6) EU/mL and (83.0±16.1) ng/L,respectively,which were higher than those of the healthy control group,25(OH)D level was (44.4±9.4) nmol/L,which was lower than that of healthy control group,and all the differences were statistically significant (t=34.555,39.716,34.293 and 0.012,all P＜0.05).The differences in LMR,endotoxin,TNF-α and 25 (OH)D levels among healthy control group,remission group,mild active group,moderate active group and severe active group were statistically significant (F=286.731,385.690,657.830 and 18.932,all P＜0.01) which was dependent on the disease activity.Compared with those of the healthy controls,the levels of LMR,endotoxin and TNF-α of the left colon group and the right colon group increased,and 25(OH)D levels decreased.The high expression rates of VDR in UC group and CD group were 36.7％ (18/49) and 55.4％ (31/ 56),respectively,which were both lower than that of healthy control group (80.0％ (36/45)),and the differences were statistically significant (x2 =38.574 and 13.837,both P＜0.05).The high expression rates of CYP27B1 of UC group and CD group were 26.5％ (13/49) and 35.7％ (20/56),respectively,which were both higher than that of healthy control group (22.2％ (10/45)),and the differences were statistically significant (x2=6.499 and 4.430,both P＜0.05).The differences in the high expression rates of VDR and CYP27B1 among healthy control group,remission group,mild active group,moderate active group and severe active group were statistically significant (F=33.470 and 27.142,both P＜0.01),which was dependent on the disease activity.Compared with that of the healthy control group,the high expression rates of VDR of the left colon group and the right colon group decreased,and the high expression rates of CYP27B1 increased.Conclusion There is vitamin D metabolic imbalance in IBD patients,as well as low serum 25(OH)D level,low rate of high VDR expression in colonic mucosa tissues and high rate of high CYP27B1.

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Comparison of the accuracy of staging in the combination of different endoscopic biopsy sites, operative link for gastritis assessment and operative link for gastric intestinal metaplasia assessment

Meng ZHANG ; 武汉市金银潭医院消化内科 ; Haibiao BAO ; Jing ZHAO ; Xiaoteng WANG ; Shuo ZHANG ; Lina MENG ; Bin LYU

Chinese Journal of Digestion.2017;37(12):806-811. doi:10.3760/cma.j.issn.0254-1432.2017.12.004

Objective To analyze the accuracy of staging among the combination of endoscopic biopsy sites,operative link for gastritis assessment (OLGA) and operative link for gastric intestinal metaplasia assessment (OLGIM) with five different biopsy sites.Methods From January 2014 to September 2015,patients with functional dyspepsia and undergoing gastroendoscopy examination were enrolled.According to update Sydney system,a total of five biopsy pieces were obtained from lesser curvature of gastric body,larger curvature of gastric body,gastric angle,larger curvature of antrum and lesser curvature of antrum.The degrees of atrophy and intestinal metaplasia were determined and staged according to OLGA and OLGIM.Kappa test and chi-square test were performed for the statistical analysis.Results A total of 268 patients were enrolled.The incidences of atrophy and intestinal metaplasia in different sites were as follow:30.4％ (113/372) and 31.0％ (111/358) in lesser curvature of antrum;26.1％(97/372) and 25.1％(90/358) in gastric angle;20.2％(75/372) and 15.4％(56/358) in larger curvature of antrum;14.8％(55/372) and 15.4％(55/358) in lesser curvature of gastric body;8.6％(32/372) and 8.1％(29/358) in larger curvature of gastric body.The incidences of atrophy and intestinal metaplasia of lesser curvature of antrum were significantly higher than those of larger curvature of gastric body,lesser curvature of gastric body and larger curvature of antrum (x2 =45.248,48.029,20.024,18.892,7.681 and 7.848;all P＜＜0.05).The incidences of atrophy and intestinal metaplasia of gastric angle were significantly higher than those of lesser curvature and larger curvature of gastric body(x2 =32.752,31.269,11.605 and 8.448;all P＜0.05).The incidences of atrophy and intestinal metaplasia of the lesser curvature of gastric body and larger curvature of antrum were higher than those of larger curvature of gastric body,and the differences were statistically significant (x2 =6.080,8.048,17.280,18.980,all P＜0.05).The incidences of mild atrophy and intestinal metaplasia of the lesser curvature of antrum were 20.2 ％ (75/ 372) and 21.2％ (76/358),respectively,which were higher than those of larger curvature of antrum (12.9％,48/372 and 12.8％,46/358),and the differences were statistically significant (x2 =5.927 and 7.377,both P＜0.05).The incidence of severe atrophy of lesser curvature of antrum was 2.4％ (9/372),respectively,which was higher than that of larger curvature of antrum (0.8％,3/372),and the difference was statistically significant (x2 =3.000,P =0.015).The incidences of mild atrophy and intestinal metaplasia of the lesser curvature of gastric body were 10.5％ (39/372) and 11.2％ (40/358),respectively,which were higher than those of larger curvature of gastric body (5.4 ％,20/372 and 5.9 ％,21/358),and the differences were statistically significant (x2 =6.119 and 5.918,both P＜0.05).The consistency of staging by three biopsy sites (lesser curvature of gastric body,gastric angle and lesser curvature of antrum) and five biopsy sites with OLGA and OLGIM was 94.0 ％ (95 ％ confidence interval (CI) =91.2％ to 96.9％,Kappa value=0.912,P＜0.01) and 92.9％ (95％CI:89.8％ to 96.0％,Kappa value=0.893,P＜0.01).Conclusion Three biopsy sites (lesser curvature of gastric body,gastric angle and lesser curvature of antrum) could accurately reflect gastric mucosa lesions with less biopsy tissues and it is worthy of clinical popularization and application.

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