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目的 观察大肠癌和腺瘤组织细胞凋亡的特征，探讨细胞凋亡和增殖在大肠癌和腺瘤组织中的意义。方法 采用脱氧核糖核酸末端转移酶介导的ｄＵＴＰ缺口末端标记（ＴＵＮＥＬ）法检测凋亡细胞，以凋亡细胞百分率作为凋亡指数（Ａｐｏｐｔｉｃｉｎｄｅｘ，ＡＩ）对１５例大肠癌、１０例腺瘤、５例正常大肠粘膜进行凋亡细胞原位观察。结果 ＴＵＮＥＬ阳性物质位于细胞核内，常聚集于核膜附近，呈新月状和块状。大肠正常粘膜ＴＵＮＥＬ阳性细胞全部位于表层上皮中，数量很少（ＡＩ＝１．７４±１．０１），腺瘤组织中ＴＵＮＥＬ阳性细胞相对较多（ＡＩ＝３３．４６±１１．３９），大肠癌组织ＴＵＮＥＬ阳性细胞散在分布，与腺瘤相比数量明显减少（ＡＩ＝１１．０８±４．２７）（Ｐ＜０．０１）。结合增殖细胞核抗原（ＰＣＮＡ）实验结果可见，腺瘤组织中ＡＩ，ＰＩ（ＰＩ＝２７．２４±７．６６）均高，而大肠癌组织中则以细胞增殖（ＰＩ＝５４．１８±１０．４１）占优势。结论 大肠肿瘤癌变过程中不仅存在活跃的细胞增殖，而且有大量的细胞凋亡，因而增加了粘膜上皮的不稳定性，高的增殖能力通过选择而占优势，从而导致癌变的发生。
Objective To observe the characteristics of apoptosis in colorectal cancer and adenoma, and to explore the significance of apoptosis and proliferation in colorectal cancer and adenoma. Methods Apoptotic cells were detected by dUTP nick end labeling (TUNEL) method mediated by DNA terminal transferase. The percentage of apoptotic cells was used as apoptosis index (Apoptic index, AI) for 15 cases of colorectal cancer, 10 cases of adenoma, 5 The normal colon mucosa was observed with apoptotic cells in situ. Results TUNEL positive material was located in the nucleus and often accumulated near the nuclear membrane, showing crescent-shaped and massive. The TUNEL positive cells in the normal mucosa of the colon were all located in the superficial epithelium with few in number (AI=1.74±1.01). The number of TUNEL positive cells in the adenoma was relatively high (AI=33.46±11.39). Tumor positive cells were scattered in the cancer tissue and were significantly reduced compared with adenomas (AI=11.08±4.27) (P<0.01). Combined with proliferating cell nuclear antigen (PCNA) experimental results, adenoma tissue AI, PI (PI = 27.24 ± 7.66) are high, while in colorectal cancer tissue proliferation (PI = 54.18 ± 10. 41) Predominance. Conclusion In the process of carcinogenesis of colorectal neoplasms, there is not only active cell proliferation but also a large number of apoptosis, which increases the epithelial instability of the mucosal epithelium. The high proliferative capacity predominates by selection, leading to the occurrence of carcinogenesis.