本文關(guān)鍵詞： 絕經(jīng)后 內(nèi)膜息肉 ER PR Ki-67 MMP-9　出處：《大連醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：子宮內(nèi)膜息肉是比較常見的婦科瘤樣病變，可發(fā)生在任何年齡，多在40-60歲，發(fā)病率國外文獻(xiàn)報(bào)道為7.8%-34.9%。與絕經(jīng)前的子宮內(nèi)膜息肉相比，絕經(jīng)后子宮內(nèi)膜息肉癌前病變及惡變率可高達(dá)4.1%。由于誘發(fā)子宮內(nèi)膜息肉的原因較多，發(fā)病機(jī)制不十分清楚，一般認(rèn)為該病與炎癥反應(yīng)及體內(nèi)雌激素、孕激素的刺激和雌激素、孕激素受體水平、細(xì)胞增殖與凋亡機(jī)制有著密切關(guān)系。本研究意在通過觀察絕經(jīng)后子宮內(nèi)膜息肉中ER、PR、MMP-9、Ki-67的表達(dá)情況，欲探討子宮內(nèi)膜息肉的相關(guān)發(fā)病機(jī)制，并尋找預(yù)測絕經(jīng)后子宮內(nèi)膜息肉惡變可能的相關(guān)蛋白，從而指導(dǎo)治療及判斷預(yù)后。 方法：實(shí)驗(yàn)中所選取的病例標(biāo)本來自我院2013年1月1日至2013年12月31日期間的手術(shù)患者，所有患者均無體重標(biāo)準(zhǔn)為肥胖情況，無高血壓病、糖尿病病史，未服用過三苯氧胺類藥物、非甾體抗炎藥，無經(jīng)歷雌孕激素替代治療病史及患其他惡性腫瘤病史。其中經(jīng)手術(shù)切取的絕經(jīng)后子宮內(nèi)膜標(biāo)本18例，經(jīng)宮腔鏡下摘除或?qū)m腔鏡手術(shù)切除的絕經(jīng)后子宮內(nèi)膜息肉標(biāo)本30例。本實(shí)驗(yàn)分為兩組，絕經(jīng)后子宮內(nèi)膜組為對照組，選取條件為平素身體健康，自然絕經(jīng)后超1年因子宮脫垂行陰式全子宮切除術(shù)，，術(shù)前超聲提示子宮萎縮，內(nèi)膜厚5mm，術(shù)中剖視大體標(biāo)本，見內(nèi)膜光滑，萎縮，經(jīng)病理證實(shí)為正常絕經(jīng)后內(nèi)膜；絕經(jīng)后子宮內(nèi)膜息肉組為實(shí)驗(yàn)組，選取條件為平素身體健康，自然絕經(jīng)后超1年因陰道排液、流血、下腹痛、常規(guī)體檢超聲提示內(nèi)膜厚≥5mm，回聲欠均勻，進(jìn)一步宮腔鏡檢查提示子宮內(nèi)膜息肉，行宮腔鏡下內(nèi)膜息肉摘除術(shù)或?qū)m腔鏡下內(nèi)膜息肉切除術(shù)，經(jīng)病理證實(shí)為子宮內(nèi)膜息肉，且排除其他內(nèi)膜病變。實(shí)驗(yàn)采用免疫組化法，檢測兩組中ER、PR、Ki一67、MMP-9在組織中的表達(dá)情況。取半定量評分方法，分析兩組中腺體及間質(zhì)細(xì)胞中陽性細(xì)胞的平均百分?jǐn)?shù)進(jìn)行評估。 結(jié)果：實(shí)驗(yàn)組與對照組中ER的表達(dá)陽性率分別為93％和78％，ER蛋白在實(shí)驗(yàn)組強(qiáng)陽性表達(dá)情況高于對照組；實(shí)驗(yàn)組與對照組中PR的表達(dá)陽性率分別為87％和67％，PR蛋白在實(shí)驗(yàn)組強(qiáng)陽性表達(dá)情況高于對照組；實(shí)驗(yàn)組與對照組中Ki一67的表達(dá)陽性率分別為53％和33％，Ki-67的陽性表達(dá)呈現(xiàn)弱陽性，且實(shí)驗(yàn)組陽性表達(dá)情況高于對照組；實(shí)驗(yàn)組與對照組中MMP-9的表達(dá)陽性率分別為33％和11％，MMP-9的陽性表達(dá)呈現(xiàn)弱陽性，且實(shí)驗(yàn)組陽性表達(dá)情況高于對照組。 結(jié)論：1）.ER、PR含量升高是促使絕經(jīng)后子宮內(nèi)膜息肉的發(fā)生；2）.Ki-67、MMP-9的表達(dá)參與了絕經(jīng)后子宮內(nèi)膜息肉的生成；3）.絕經(jīng)后子宮內(nèi)膜息肉中Ki一67、MMP-9的表達(dá)不能作為子宮內(nèi)膜息肉向子宮內(nèi)膜癌發(fā)展的預(yù)測指標(biāo)。
[Abstract]:Objective: endometrial polyps are common gynecologic tumor-like lesions, which can occur at any age, mostly in 40-60 years old. The incidence rate of endometrial polyps was reported as 7.8- 34.9. compared with premenopausal endometrial polyps. The rate of precancerous lesion and malignant change of endometrial polyps after menopause can be as high as 4.1. Because there are many reasons to induce endometrial polyps, the pathogenesis of endometrial polyps is not very clear. It is generally believed that the disease is associated with inflammatory reaction and estrogen in vivo. Progesterone stimulation is closely related to estrogen, progesterone receptor, cell proliferation and apoptosis mechanism. This study was designed to observe ERP PR-MMP-9 in postmenopausal endometrial polyps. To explore the pathogenesis of endometrial polyps and to find the related proteins to predict the malignant change of postmenopausal endometrial polyps, the expression of Ki-67 could guide the treatment and judge the prognosis of endometrial polyps. Methods: all the patients were selected from our hospital from January 1st 2013 to December 31st 2013. All the patients had no obesity and no hypertension. There were no history of diabetes, no tamoxifen, no steroidal anti-inflammatory drugs, no history of estrogen and progesterone replacement therapy and other malignant tumors. 18 cases of postmenopausal endometrial specimens were surgically removed. Thirty cases of postmenopausal endometrial polyps were removed by hysteroscopy or hysteroscopic surgery. This experiment was divided into two groups: the postmenopausal endometrium group was the control group, and the condition was normal body health. Vaginal hysterectomy due to uterine prolapse was performed more than 1 year after natural menopause. Preoperative ultrasound revealed uterine atrophy and endometrial thickness of 5 mm. Normal postmenopausal intima was confirmed by pathology. The group of postmenopausal endometrial polyps as the experimental group, select the condition of normal physical health, natural menopause more than one year due to vaginal effusion, bleeding, lower abdominal pain, the conventional ultrasound showed that the thickness of the endometrium 鈮

本文編號：1459780