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目的研究老年人结肠息肉的临床特点及其与癌变的关系。探讨高危型腺瘤与TGF-β信号通路蛋白表达的关系。方法对我院近几年经结肠镜检出的82例老年患者(≥60岁)结肠息肉的临床资料,观察其临床特点、内镜下表现及病理类型,并与96例中青年组(20～59岁)患者结肠息肉相比较。选取其中结直肠息肉标本110例,结直肠癌10例,以免疫组化染色检测TGF-β1、Smad3、Smad4在各组中的表达,并分析高危型腺瘤中TGF-β1、Smad3、Smad4表达与临床病理特征的关系。结果老年人结肠息肉的检出率高于中青年组,随年龄增加有升高趋势,病理类型以腺瘤为主。TGF-β1、Smad3、Smad4,在息肉组、结直肠癌组中的表达有显著差异(P<0.05),其表达与高危型腺瘤患者的临床病理特征均不相关。高危型腺瘤和DukesA期结直肠癌中TGF-β1、Smad3的表达有显著差异(P<0.05),而Smad4表达无显著差异。结论老年人大肠息肉中的腺瘤性息肉的大小、形态、数量及病理类型是其癌变的主要危险因素。TGF-β1通路可能参与了结直肠癌的发生过程,TGF-β1、Smad3可能在结直肠腺瘤的癌变早期起作用。
Objective To study the clinical features of colorectal polyps in the elderly and its relationship with carcinogenesis. To investigate the relationship between high-risk adenoma and TGF-β signaling pathway protein expression. Methods The clinical data of 82 cases of colonic polyps detected by colonoscopy in our hospital in recent years were retrospectively analyzed. The clinical features, endoscopic features and pathological types of 82 cases of colorectal polyps were analyzed. ~ 59 years old) patients with colonic polyps compared. One hundred and ten cases of colorectal polyps and 10 cases of colorectal cancer were selected for immunohistochemical staining to detect the expression of TGF-β1, Smad3 and Smad4 in each group, and to analyze the expression of TGF-β1, Smad3 and Smad4 in high- And clinicopathological features. Results The detection rate of colonic polyps in the elderly was higher than that in the middle-aged and young adults, with the increasing trend of age. The pathological type was mainly adenoma. The expression of TGF-β1, Smad3 and Smad4 in polyp group and colorectal cancer group were significantly different (P <0.05). The expression of TGF-β1, Smad3 and Smad4 was not correlated with the clinicopathological features of high-risk adenoma. The expression of TGF-β1 and Smad3 in high-risk adenocarcinoma and DukesA stage colorectal cancer were significantly different (P <0.05), while the expression of Smad4 was not significantly different. Conclusion The size, shape, quantity and pathological type of adenomatous polyps in the colorectal polyps of the elderly are the main risk factors of carcinogenesis. TGF-β1 pathway may be involved in the development of colorectal cancer, TGF-β1, Smad3 may play an important role in colorectal adenoma carcinogenesis.