【摘要】 目的 通过比较胃底贲门正常组织和癌组织中Ⅲ、Ⅳ型胶原蛋白分布差异，分析胃底贲门组织癌变后Ⅲ、Ⅳ型胶原蛋白分布的改变对组织的自体荧光产生的影响。方法 采用免疫组化技术,半定量计分分析Ⅲ、Ⅳ型胶原在16例贲门癌病人正常组织和癌组织中的分布差异。结果 正常组织的基底膜呈现很强的Ⅳ型胶原抗体阳性反应,在基底膜形成较粗的环形染色带；Ⅲ型胶原抗体阳性反应在细胞外间质呈连续的细丝纤维样。癌组织Ⅳ型胶原抗体反应在癌巢周边为阴性,或仅在残存的基底膜有片断的阳性反应；而Ⅲ型胶原在癌间质中的抗体阳性反应较正常组织变化不明显,或还稍有增强；Ⅲ型和Ⅳ型在正常组织和癌组织中的分布差异有极其显著性(P<0.001)。结论 胃底贲门组织癌变后,细胞外基质内Ⅳ型胶原显著减少，而Ⅲ型胶原减少不明显；Ⅳ型胶原是胃底贲门黏膜细胞外基质自体荧光的主要来源；组织发生癌变后，细胞外基质中Ⅳ型胶原的降解是癌组织自体荧光减弱的主要原因之一。

    【关键词】 自体荧光；贲门癌；Ⅲ、Ⅳ型胶原；荧光物质

    Significance of the collagen type Ⅳ in auto-fluorescence diagnosis of cardiac cancer

    CHEN Sheng-lin,LI Wei,ZENG Yong-ming,et al.

    Department of General Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041,China

    【Abstract】 Objective To compare the distribution of collagen typeⅢ and Ⅳ in mucosa of normal and carcinoma cardiac tissues and to analyze the influence of changed collagen on auto-fluorescence after canceration.Methods Using immunohistochemical technique with monoclonal anti-collagen typeⅢ and Ⅳ, difference in distribution in extracellular matrix of two types collagen between normal and carcinoma tissues from 16 patients were measured with semi-quantitative score methods.Results In normal mucosa, the epithelial basement membrane showed an intense positive reaction for monoclonal anti-collagenⅣ and an intensively stained ring band was formed around the grand basement membrane；collagen typeⅢ formed ring-like structures apparently representative of fibriform collagen immediately adjacent to the epithelial basement membrane. In carcinomatous mucosa, immunoreaction of the carinomatous cell nest was negative, or only remnants of positively were seen at the site of the former membrane by collagen type Ⅳ. The change of collagen typeⅢ was not apparent, or positives reaction in carcinomatous stroma was more intensity than in normal stroma. There were significant differences in distribution of collagen typeⅢ and Ⅳbetween normal and carcinomatous tissues(P<0.001).Conclusion After cardiac cancer occurring, collagen type Ⅳ in basement membrane and stroma decreased significantly, but collagen typeⅢ remained unchanged.The main collagen located in basement membrane was collagen type Ⅳand it was the main source of laser-induced auto-fluorescence in cardiac cancer basement membrane. After cancer occurring,the degradation of collagen type Ⅳ in basement membrane and stroma was the main causes of reduced intensity of laser-induced auto-fluorescence in carcinomatous tissues. ......