Helicobacter pylori 감염과 관련된 전암성 및 암성 위병변에서 상피세포 증식에 관한 연구
A study on the epithelial proliferation in Helicobacter pylori associated gastric premalignant and malignant lesions
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Background : Many studies have demonstrated that increased cell proliferation in gastric epithelium is associated with Helicobacter pylori (H. pylori) infection. Increased epithelial proliferation is one of the earliest mucosal changes observed in gastric carcinogenesis. The aim of this study was to evaluate the influence of H. pylori infection for epithelial proliferation at different stages of gastric carcinogenesis from chronic gastritis to adenocarcinoma. Methods : Gastric biopsy specimens were collected from 129 patients who underwent esophagogastroduodenoscopy with biopsy. Histologically, there were 29 patients with chronic gastritis, 26 chronic gastritis with intestinal metaplasia, 31 low grade dysplasia, 18 high grade dysplasia, and 25 gastric adenocarcinoma. Status of H. pylori infection was determined by rapid urease test, modified Giemsa stain and 13C-urea breath test. Epithelial cell proliferation was assessed by immunohistochemical method using anti-PCNA antibody. Results : The grade of epithelial proliferation was higher in H. pylori infected patients than uninfected patients (p=0.007) and progressively increased at different stages from chronic gastritis to gastric adenocarcinoma (p<0.001). The analysis of epithelial proliferation according to H. pylori infection status in each histologic group showed that the grades of epithelial proliferation were higher in H. pylori infected patients than uninfected patients in all groups except adenocarcinoma group. Conclusion : H. pylori infection causes increased gastric epithelial cell proliferation and may play an important role in gastric carcinogenesis.
Abstract
목적 : H. pylori 감염이 위상피세포 증식의 증가와 관련되어 있다는 많은 연구 보고들이 있으며, 이러한 상피세포의 증식은 위암 발암과정 중 초기단계에 관여한다고 알려져 있다. 본 연구의 목적은 만성 위염에서 위암으로 진행하는 각 단계에 있어 H. pylori 감염이 상피세포 증식에 미치는 영향에 대해 알아보고자 하였다. 방법 : 상부 위장관 증상으로 내원하여 상부위장관 내시경 및 조직생검을 시행 받았던 129예(만성위염 29예, 장형화생을 동반한 만성 위축성 위염 26예, 저등급 형성이상 31예, 고등급 형성이상 18예, 위선암 25예)를 대상으로 하고, H. pylori 감염 여부를 신속요소분해효소검사, 변형 Giemsa 염색, 요소호기검사를 이용하여 평가하였고, 상피세포의 세포 증식능은 항 PCNA 항체를 이용한 면역조직화학염색을 통해 평가하였다. 결과 : 위상피세포 증식능의 정도는 H. pylori 양성군이 음성군에 비해 통계학적으로 유의하게 더 높았으며(p=0.007), 대상군을 위염군, 형성이상군, 그리고 위선암군으로 나누었을 때 위염군에서 위선암군으로 진행할수록 유의하게 증가하였다(p<0.001). 각각의 조직학적인 군별로 H. pylori 감염에 따른 세포증식능을 비교한 결과 위선암군을 제외한 나머지 군에서 모두 H. pylori 양성이 음성인 경우보다 세포 증식능이 높았다. 결론 : H. pylori 감염은 상피세포 증식증가에 관여하며, 위암의 발암과정 중 초기에 관여할 것으로 생각된다.
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