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血清同型半胱氨酸水平在胃癌和癌前疾病中作用的临床研究*

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上海梅山医院消化科1(210039)南京医科大学第一附属医院老年医学科2东南大学附属中大医院消化科3

背景：近年研究发现同型半胱氨酸(Hcy)水平增高能增加胃癌的发病风险，但其在胃癌癌前疾病中的作用未见相关研究。目的：探讨血清Hcy、叶酸和维生素B12在胃癌及其癌前疾病中的作用。方法：选取经胃镜和病理检查确诊的86名正常对照者、46例萎缩性胃炎、46例胃溃疡、31例胃息肉、52例胃癌患者，检测血清Hcy、叶酸和维生素B12水平，分析其与胃癌临床病理特征的关系。结果：与对照组相比，萎缩性胃炎组和胃癌组血清Hcy水平显著增高(P<0.05)；胃溃疡组、胃息肉组和胃癌组叶酸和维生素B12水平显著降低(P<0.05)。胃癌组血清Hcy水平与肿瘤浸润深度、TNM分期和淋巴结转移呈正相关(P<0.05)，而叶酸和维生素B12与胃癌临床病理特征无明显相关性。结论：萎缩性胃炎、胃癌的Hcy水平增高，胃溃疡、胃息肉和胃癌的叶酸和维生素B12水平降低。高Hcy水平参与了胃癌的浸润和转移，对高Hcy、低叶酸和维生素B12水平者进行干预可能是防治胃癌及其癌前疾病的一种有效策略。

关键词同型半胱氨酸；叶酸；维生素B12；胃肿瘤；癌前疾病

Clinical Study on Role of Serum Homocysteine Level in Gastric Cancer and Precancerous Diseases

CHANSongmiao1,SUNWeihao2,ZHUXiaobing1,OUXilong3.

1DepartmentofGastroenterology,ShanghaiMeishanHospital,Nanjing(210039);2DepartmentofGeriatrics,theFirstAffiliatedHospitalwithNanjingMedicalUniversity,Nanjing;3DepartmentofGastroenterology,theAffiliatedZhongdaHospitalofClinicalMedicalCollegeofSoutheastUniversity,Nanjing

Correspondence to: OU Xilong, Email: ouxilong@126.com

Background: Recent studies have showed that high homocysteine (Hcy) level can increase the risk of gastric cancer, but no related studies have been reported on role of Hcy in gastric precancerous diseases. Aims: To investigate the role of serum Hcy, folic acid and vitamin B12in patients with gastric cancer and precancerous diseases. Methods: Eighty-six normal controls, 46 atrophic gastritis, 46 gastric ulcer, 31 gastric polyp, 52 gastric cancer patients diagnosed by gastroscopy and pathology were enrolled. Serum levels of Hcy, folic acid and vitamin B12were determined, and their correlations with clinicopathological features in gastric cancer were analyzed. Results: Compared with normal controls, serum Hcy level in patients with atrophic gastritis and gastric cancer was significantly increased (P<0.05); serum folic acid and vitamin B12levels in patients with gastric ulcer, gastric polyp and gastric cancer were significantly decreased (P<0.05). Serum Hcy level in patients with gastric cancer was positively correlated with depth of tumor infiltration, TNM staging and lymph node metastasis (P<0.05), however, serum folic acid and vitamin B12levels had no correlation with clinicopathological features. Conclusions: Hcy level is increased in chronic atrophic gastritis, gastric cancer; levels of folic acid and vitamin B12are decreased in gastric ulcer, gastric polyp and gastric cancer. High level of Hcy is involved in infiltration and metastasis of gastric cancer. Intervention in patients with high level of Hcy, low levels of folic acid and vitamin B12might be an effective strategy for the prevention and treatment of gastric cancer and precancerous diseases.

Key wordsHomocysteine;Folic Acid;Vitamin B 12;Stomach Neoplasms;Precancerous Diseases

同型半胱氨酸(Hcy)是蛋氨酸分解代谢的重要中间产物。由于Hcy具有细胞毒性、神经毒性和基因毒性，可造成细胞增殖性改变，如鳞状上皮增生、上皮异型增生等。近年Hcy在恶性肿瘤发病机制中的作用已引起关注[1-2]。有研究发现食管癌、肝癌、乳腺癌患者血清Hcy水平升高[3-4]，高Hcy水平能增加胃癌的发病风险[5]，但Hcy在胃癌前疾病中的表达情况目前缺乏相关研究。本研究通过检测萎缩性胃炎、胃溃疡、胃息肉和胃癌患者血清Hcy、叶酸和维生素B12水平，旨在探讨Hcy在胃癌发病中的可能作用，为临床补充叶酸和维生素B12防治胃癌和癌前疾病提供理论依据。

对象与方法

一、研究对象

选取2011年1月—2013年12月至上海梅山医院行胃镜检查的门诊和住院患者261例，诊断由组织病理学明确。……