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Клинико-эндоскопические, лабораторные и иммуноморфологические показатели в прогнозировании возникновения колоректального рака у больных с дивертикулярной болезнью толстой кишки
DOI: 10.26442/00403660.2024.08.202818
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
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Svistunov AА, Osadchuk MA, Mironova ED, Krylova IuS. Clinical, endoscopic, laboratory and immunomorphological parameters in predicting the occurrence of colorectal cancer in patients with diverticular disease of the colon. Terapevticheskii Arkhiv (Ter. Arkh.). 2024;96(8): 732–738. DOI: 10.26442/00403660.2024.08.202818
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Материалы и методы. Обследованы 175 человек с ДБТК. Больные разделены на 3 группы: 1-я группа – 85 пациентов с ДБТК; 2-я группа – 45 пациентов с ДБТК в сочетании с аденоматозными полипами (АП); 3-я группа – 45 с ДБТК с установленным КРР (I или II стадии). Группу контроля составили 30 практически здоровых человек. Больные и здоровые обследованы по единой программе, включающей клинические, лабораторные, инструментальные и иммуноморфологические методы [использование первичных антител к p53 (mAb clone DO-7 product no. PA0057, Leica Biosystems, Leica Bond III) и Ki-67(Ab16667, Abcam, UK)] исследования.
Результаты. У пациентов с ДБТК и КРР запор встречался чаще, чем у пациентов с ДБТК и ДБТК с АП (p<0,05). У пациентов с ДБТК и колоректальной неоплазией чаще верифицировали положительную реакцию на скрытую кровь в кале по сравнению с группой с ДБТК (p<0,05). Показатели содержания глюкозы и холестерина в плазме крови, а также индекса массы тела у больных с ДБТК в сочетании с АП и КРР оказались выше, чем у лиц с ДБТК (p<0,05). У пациентов с ДБТК в сочетании с АП и КРР определялся достоверно более высокий уровень экспрессии Ki-67 и p53 по сравнению с пациентами с ДБТК без колоректальной неоплазии (p<0,05). При этом у пациентов с ДБТК в сочетании с КРР уровень экспрессии Ki-67 и p53 оказался выше, чем у пациентов с ДБТК, имеющих АП (p<0,05).
Заключение. У пациентов с ДБТК в сочетании с АП и КРР определялись более высокие показатели глюкозы, холестерина в плазме крови, а также индекса массы тела по сравнению с группой больных с ДБТК (p<0,05). При этом результаты определения Ki-67 и p53 в слизистой оболочке толстого кишечника необходимо рассматривать как важные прогностические маркеры развитии КРР у пациентов с ДБТК.
Ключевые слова: дивертикулярная болезнь, толстый кишечник, Ki-67, p53, колоректальный рак, аденоматозный полип
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Aim. To define the role of clinical, endoscopic, laboratory and immunomorphological parameters in predicting the occurrence and course of colorectal cancer (CRC) in patients with diverticular disease of the colon (DDC).
Materials and methods. One hundred and seventy five people with DDC were examined, divided into 3 groups: group 1 – 85 patients with DDC; group 2 – 45 with DDC in combination with adenomatous polyps (AP); 3rd group – 45 with DDC with established CRC (I or II stage). The control group consisted of 30 practically healthy people. Patients and healthy people were examined according to a single program: clinical, laboratory, instrumental data and immunomorphological research methods [use of primary antibodies to p53 (mAb clone DO-7 product no. PA0057, Leica Biosystems, Leica Bond III) and Ki-67 (Ab16667, Abcam, UK)].
Results. Among the main complaints in patients with DDC and CRC, constipation was more common than in patients with DDC and DDC with AP (p<0.05). In patients with DDC and colorectal neoplasia, a positive reaction to occult blood in the feces was more often verified, compared with the group with DDC (p<0.05). Higher levels of glucose and cholesterol in blood plasma, as well as body mass index were found in patients with DDC with AP and CRC, compared with the DDC group (p<0.05). A higher level of expression of Ki-67 and p53 was found in patients with DDC combined with AP and CRC, compared with patients with DDC without colorectal neoplasia (p<0.05). At the same time, in patients with DDC with CRC, the expression level of Ki-67 and p53 was higher than in patients with DDC with AP (p<0.05)
Conclusion. In patients with DDC combined with AP and CRC, higher levels of glucose, plasma cholesterol, as well as body mass index were observed compared to the group of patients with DDC alone (p<0.05). Of note, the results of the determination of Ki-67 and p53 in the mucous membrane of the colon should be considered important prognostic markers for the development of CRC in patients with DDC.
Keywords: diverticular disease, large intestine, Ki-67, p53, colorectal cancer, adenomatous polyp
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5. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. DOI:10.3322/caac.21492
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7. Zhang Y, Zhang H, Zhu J, et al. Association between diverticular disease and colorectal cancer: a bidirectional mendelian randomization study. BMC Cancer. 2023;23:137. DOI:10.1186/s12885-023-10606-x
8. Stefánsson T, Ekbom A, Sparèn P, Påhlman L. Association between sigmoid diverticulitis and left-sided colon cancer: a nested, population-based, case control study. Scand J Gastroenterol. 2004;39(8):743-7. DOI:10.1080/00365520410003272
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DOI:10.1136/jclinpath-2012-200911
1ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
2ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова» Минздрава России, Санкт-Петербург, Россия;
3ФГБУ «Санкт-Петербургский научно-исследовательский институт фтизиопульмонологии» Минздрава России, Санкт-Петербург, Россия
*osadchuk.mikhail@yandex.ru
________________________________________________
Andrey А. Svistunov1, Mikhail A. Osadchuk*1, Ekaterina D. Mironova1, Iuliia S. Krylova2,3
1Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
2Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia;
3Saint-Petersburg State Research Institute of Phthisiopulmonology, Saint Petersburg, Russia
*osadchuk.mikhail@yandex.ru