Nihat AKBAKIR, Nilgün DEMİRBAĞ, ŞULE POTUROĞLU, Kadir ERGEN, Mehmet KENDİR

Diffüz antral gastrit ve multifokal atrofik gastritli hastalarda mide sıvısı askorbik asit düzeyleri ve epitel hücre proliferasyonlarının karşılaştırılması

Giriş ve amaç: Diffüz antral gastrit (DAG), kronik Helicobacter pylori gastritinin duodenal ülser fenotipini, multifokal atrofik gastrit (MAG) ise gastrik kanser fenotipini oluşturmaktadır. Bu çalışmada DAG ve MAG’lı olgularda gastrik sıvı askorbik asit düzeylerinin incelenmesi, grupların mide epitel hücre proliferasyon oranları açısından karşılaştırılması ve mide sıvısı askorbik asit (C vitamini) düzeyleriyle hücre proliferasyon oranları arasındaki olası korelasyonların araştırılması amaçlanmıştır. Gereç ve yöntem: H. pylori’ye bağlı 27 MAG, 10 DAG saptanan 37 hasta çalışmaya alındı (22 kadın, 15 erkek, 19-74, yaş ort: 43,6). Hastaların plazma ve gastrik sıvı örneklerinde askorbik asit düzeyleri ölçüldü. Olguların antrum ve korpuslarında hücre proliferasyonundan dolayı foveolar epiteldeki maturasyon kaybının varlığı, sitokeratin-20 (CK-20) antikoru kullanılarak immunohistokimyasal yöntemle gösterildi. Bulgular: Her iki grubun plazma askorbik asit düzeyleri arasında anlamlı farklılık yoktu. Gruplar, mide sıvısı askorbik asit düzeyleri açısından karşılaştırıldığında istatistiksel anlamlı bir farklılık gözlenmedi (DAG ve MAG için sırasıyla; 0.93±0.97, 0.96±1.12mg/dl, p > 0.05) MAG grubunda CK-20 için boyanma yüzdesi DAG grubundakilere göre anlamlı derecede düşüktü (%74.7 ve %90.9, p < 0.01). Boyanma yüzdeleriyle mide sıvısı askorbik asit değerleri arasında bir korelasyon saptanmadı. Sonuç: Bu çalışmada diffüz antral gastrit ve multifokal atrofik gastritli hastalar arasında mide sıvısı askorbik asit düzeyleri açısından anlamlı farklılık bulunmamıştır. Ancak, multifokal atrofik gastritin intestinal tip gastrik karsinogenez sürecinin proksimal aşamalarında yer aldığını destekleyecek şekilde, bu gastrit formunda epitel hücre proliferasyonunun artmış olduğu gösterilmiştir.

Anahtar Kelimeler:

Askorbik asit, H. pylori, kronik gastrit, hücre proliferasyonu

Comparison of the patients with diffuse antral and multifocal atrophic gastritis for gastric juice ascorbic acid levels and epithelial cell proliferations

Background/aim: Diffuse antral gastritis (DAG) is a duodenal ulcer phenotype of chronic Helicobacter pylori gastritis, while multifocal atrophic gastritis (MAG) is a gastric cancer phenotype. The aim of this study was to investigate ascorbic acid (vitamin C) levels in the gastric juice in patients with DAG and MAG, to compare the gastric epithelial cell proliferation rates between the groups and also to examine any correlation between ascorbic acid levels in gastric juice and the cell proliferation rates. Materials and methods: Thirty-seven patients with chronic H. pylori gastritis (27 MAG, 10 DAG) were included in the study (male/female: 15/22, range: 19-74, mean age: 43.6 yrs). Ascorbic acid concentrations in fasting plasma and gastric juice samples of the patients were measured. Loss of maturation in foveolar epithelium due to cell proliferation was shown immunohistochemically using cytokeratin-20 antibody in antral and corporal regions of both patient groups. Results: There was no significant difference in plasma ascorbic acid levels between the two groups. No statistically significant difference could be demonstrated in gastric juice ascorbic acid concentrations between patients with DAG and MAG (0.93±0.97 mg/dl and 0.96±1.12 mg/dl, respectively; p>0.05). Immunohistochemical examination revealed that staining for cytokeratin- 20 was significantly less in MAG patients than in those with DAG (74.7% vs 90.9%, respectively; p

Keywords:

Ascorbic acid, H. pylori, chronic gastritis, cell proliferation,

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