窄带成像内镜、染色内镜及常规内镜模式诊断结直肠增生性病变的应用价值比较研究

目的:探讨窄带成像内镜(NBI)、染色内镜及常规内镜模式鉴别诊断非肿瘤性、肿瘤性结直肠增生性病变的应用价值。方法:选择2017年2月至2019年3月西安市中心医院消化科收治的结直肠增生性病变患者,均行NBI、染色内镜、常规内镜检查。比较三种模式图像清晰度以及鉴别诊断非肿瘤性、肿瘤性结直肠增生性病变的效能。结果:NBI、染色内镜模式图像质量评分分布优于常规内镜(P<0.05),NBI图像质量评分分布优于染色内镜模式(P<0.05)。以病理结果为准,常规内镜结直肠增生性病变检出率73.13%,NBI 91.04%,染色内镜96.26%,NBI、染色内镜结直肠增生性病变检出率高于常规内镜(P<0.05),NBI、染色内镜比较无统计学差异(P>0.05)。NBI模式下检测NBI分型与病理组织学结果一致性较好(kappa值=0.801,P<0.05)。NBI、染色内镜诊断肿瘤性结直肠增生性病变的灵敏度、特异度、阳性预测值、阴性预测值、准确度均明显高于常规内镜,染色内镜、NBI、常规内镜诊断肿瘤性结直肠增生性病变的曲线下面积(AUC)分别为0.844(95%CI:0.812~0.956)、0.921(95%CI:0.860~0.982)、0.750(95%CI:0.651~0.848)。结论:NBI、染色内镜在鉴别非肿瘤性和肿瘤性结直肠增生性病变方面效能相似,均优于常规内镜,NBI分型与病理组织学结果一致性高,更适合结直肠增生性病变的鉴别诊断。     

Effect of Redox Balance Alterations on Cellular Localization of LAT and Downstream T-Cell Receptor Signaling Pathways

The integral membrane protein linker for activation of T cells (LAT) is a central adapter protein in the T-cell receptor (TCR)-mediated signaling pathways. The cellular localization of LAT is extremely sensitive to intracellular redox balance alterations. Reduced intracellular levels of the antioxidant glutathione (GSH), a hallmark of chronic oxidative stress, resulted in the membrane displacement of LAT, abrogated TCR-mediated signaling and consequently hyporesponsiveness of T lymphocytes. The membrane displacement of LAT is accompanied by a considerable difference in the mobility of LAT upon native and nonreducing denaturing polyacrylamide gel electrophoresis analysis, a finding indicative of a conformational change. Targeted mutation of redox-sensitive cysteine residues within LAT created LAT mutants which remain membrane anchored under conditions of chronic oxidative stress. The expression of redox-insensitive LAT mutants allows for restoration of TCR-mediated signal transduction, whereas CD28-mediated signaling pathways remained impaired. These results are indicative that the membrane displacement of LAT as a result of redox balance alterations is a consequence of a conformational change interfering with the insertion of LAT into the plasma membrane. Conclusively, the data suggest a role for LAT as a crucial intermediate in the sensitivity of TCR signaling and hence T lymphocytes toward chronic oxidative stress.