本文關鍵詞： 經(jīng)直腸多普勒超聲 前列腺癌分型 組織分化 浸潤轉移 蛋白表達　出處：《大連醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的：本文旨在通過對不同超聲分型的前列腺癌結合病理及K-ras、EGFR、MMP2及MMP9表達情況的研究，探討各超聲分型前列腺癌組織分化及浸潤轉移的特點，從而通過應用經(jīng)直腸彩色多普勒超聲來判斷各超聲分型前列腺癌的發(fā)生發(fā)展及預后，，為臨床診斷治療方案的制定提供更可靠的理論依據(jù)。 方法：2012年3月～2014年1月期間在我院行超聲引導下前列腺穿刺活檢的前列腺疾病病例共138例，其中病理確診為前列腺癌74例，前列腺上皮內(nèi)瘤變（prostatintraepithelial neoplasia PIN）25例，前列腺增生39例。①收集74例前列腺癌病例經(jīng)直腸二維及三維超聲圖像資料，進行回顧性統(tǒng)計分析，借鑒以往徐萍的研究，將所收集的前列腺癌超聲圖像按照單純結節(jié)型、結節(jié)浸潤型、彌漫浸潤型進行分型；在病理組織分化、浸潤轉移程度及與PIN、前列腺增生病例間的差異等方面，對不同超聲分型前列腺癌加以比較；②對病理組織學標本行免疫組化染色，研究并比較各組前列腺癌、PIN及增生組織中K-ras、EGFR、MMP2及MMP9蛋白表達情況。 結果：①單純結節(jié)型（30例）：低分化腺癌4例、轉移0例；結節(jié)浸潤型（20例）：低分化腺癌14例、轉移15例；彌漫浸潤型（24例）：低分化腺癌20例、轉移19例。結節(jié)浸潤型及彌漫浸潤型前列腺癌中的低分化腺癌病例及浸潤轉移（C+D期）病例所占的比率明顯高于單純結節(jié)型（P＜0.05），但前二者無明顯差異（P＞0.05）。②三種分型前列腺癌及PIN組中K-ras蛋白表達陽性率及強陽性率和EGFR蛋白表達陽性率較增生組均明顯增高（P＜0.05）；結節(jié)浸潤型和彌漫浸潤型前列腺癌中K-ras蛋白表達陽性率及強陽性率和EGFR蛋白表達陽性率較單純結節(jié)型及PIN組也明顯增高（P＜0.05）；單純結節(jié)型前列腺癌中K-ras蛋白表達陽性率及強陽性率和EGFR蛋白表達陽性率與PIN組無明顯差異（P＞0.05）；結節(jié)浸潤型與彌漫浸潤型前列腺癌中K-ras蛋白表達陽性率及強陽性率和EGFR蛋白表達陽性率均無明顯差異（P＞0.05）。③三種分型前列腺癌及PIN組中MMP2蛋白表達陽性率和MMP9蛋白表達陽性率及強陽性率較增生組均明顯增高（P＜0.05）；結節(jié)浸潤型和彌漫浸潤型前列腺癌中MMP2蛋白表達陽性率和MMP9蛋白表達陽性率及強陽性率較單純結節(jié)型及PIN組也明顯增高（P＜0.05）；單純結節(jié)型前列腺癌的MMP2蛋白表達陽性率和MMP9蛋白表達陽性率及強陽性率與PIN組無明顯差異（P＞0.05）；結節(jié)浸潤型與彌漫浸潤型前列腺癌MMP2蛋白表達陽性率和MMP9蛋白表達陽性率及強陽性率均無明顯差異（P＞0.05）。結論：前列腺癌的發(fā)生發(fā)展過程中，單純結節(jié)型前列腺癌的分化程度較高且無遠處轉移，其惡性度較低，組織特性方面與PIN結節(jié)較接近，故可以考慮隨診觀察，待機處理；結節(jié)浸潤型與彌漫浸潤型前列腺癌的分化程度較低，且易發(fā)生遠處轉移，其惡性度較高，故建議應盡早行手術治療。
[Abstract]:Objective: to investigate the characteristics of differentiation, invasion and metastasis of prostate cancer by studying the expression of MMP2 and MMP9 in prostate cancer with different types of ultrasound. Therefore, transrectal color Doppler ultrasound was used to judge the occurrence, development and prognosis of prostate cancer, and to provide a more reliable theoretical basis for clinical diagnosis and treatment. Methods: from March 2012 to January 2014, a total of 138 patients with prostatic diseases underwent ultrasound guided prostatic biopsy in our hospital, including 74 cases of prostate cancer and 74 cases of prostatic intraepithelial neoplasia PIN)25. Thirty-nine cases of benign prostatic hyperplasia (BPH) were collected from 74 cases of prostate cancer by transrectal two-dimensional and three-dimensional ultrasound images. The data were statistically analyzed retrospectively. According to the previous studies of Xu Ping, the collected ultrasound images of prostate cancer were classified as simple nodular type. Nodular infiltrative type, diffuse infiltrative type, differentiation of pathological tissue, degree of invasion and metastasis, difference with PINand prostatic hyperplasia, and so on. Immunohistochemical staining was used to study and compare the expression of K-ras-EGFRMMP2 and MMP9 protein in the tissues of prostate cancer with different types of ultrasound. Results in 30 cases of simple nodular carcinoma, 4 cases of poorly differentiated adenocarcinoma, 0 cases of metastasis, 20 cases of nodular infiltrative carcinoma, 14 cases of poorly differentiated adenocarcinoma, 15 cases of metastasis, 24 cases of diffuse infiltrative carcinoma and 20 cases of poorly differentiated adenocarcinoma. There were 19 cases of metastasis. The proportion of poorly differentiated adenocarcinoma and infiltrating metastatic stage C D in nodular infiltrating type and diffuse infiltrating type of prostate cancer was significantly higher than that in simple nodular carcinoma (P < 0.05), but there was no significant difference between the former two types (P > 0.05). The positive rate of K-ras protein expression and strong positive rate of K-ras protein and positive rate of EGFR protein expression in PIN group were significantly higher than those in hyperplasia group (P < 0.05), the positive rate and strong positive rate of K-ras protein expression and EGFR in nodular infiltrating type and diffuse infiltrating type of prostate cancer were significantly higher than those in proliferative group (P < 0.05). The positive rate of protein expression was significantly higher than that of simple nodular type and PIN group (P < 0.05), but the positive rate of K-ras protein expression and strong positive rate of EGFR protein expression in simple nodular type prostate cancer was not significantly different from that of PIN group (P > 0.05), and the nodule infiltrating type and Mian group had no significant difference compared with PIN group (P > 0.05). There was no significant difference in the positive rate of K-ras protein expression, strong positive rate and EGFR protein expression in diffuse invasive prostate cancer (P > 0.05). 3 positive rates of MMP2 protein expression, MMP9 protein expression and strong positive positive rate of MMP9 protein in three types of prostate cancer and PIN group were not significantly different (P > 0.05). The positive rate of MMP2 protein, MMP9 protein expression and strong positive rate in nodular infiltrating type and diffuse infiltrating type of prostate cancer were significantly higher than those of simple nodular type and PIN group (P < 0.05), and the positive rate of MMP2 protein and MMP9 protein expression in nodular type and diffuse infiltrating type of prostate cancer were significantly higher than those in simple nodular type and PIN group (P < 0.05). The positive rate of MMP2 protein expression, MMP9 protein expression and strong positive rate of prostate cancer were not significantly different from those of PIN group (P > 0.05), the positive rate of MMP2 protein expression, MMP9 protein expression and strong positive rate of nodular infiltrating type and diffuse infiltrating type prostate cancer were not significantly different from those of PIN group (P > 0.05). There was no significant difference in the positive rates between the two groups (P > 0.05). Conclusion: during the development of prostate cancer, Simple nodular prostate cancer has high differentiation and no distant metastasis, its malignancy is low, and its tissue characteristics are close to PIN nodules, so it can be considered to follow up and wait for treatment. The degree of differentiation between nodular infiltrating prostate cancer and diffuse infiltrating prostate cancer is low, and it is easy to metastasize far away, and its malignant degree is higher. Therefore, it is suggested that surgical treatment should be carried out as soon as possible.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.1;R737.25

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