本文選題：妊娠滋養(yǎng)細(xì)胞疾病　切入點(diǎn)：惡性程度　出處：《新疆醫(yī)科大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：(1)比較新疆部分區(qū)域維、漢民族妊娠滋養(yǎng)細(xì)胞疾病發(fā)病差異性；(2)分析E-粘鈣素(E-cadherin)在正常早孕絨毛組織、葡萄胎組織、侵蝕性葡萄胎組織及絨毛膜癌組織中表達(dá)強(qiáng)度,探討其與滋養(yǎng)細(xì)胞惡性潛能的關(guān)系；(3)對(duì)惡性轉(zhuǎn)化的葡萄胎患者進(jìn)行回顧性分析總結(jié)其高危因素。方法：(1)選擇自2008年3月至2013年3月在新疆醫(yī)科大學(xué)第一附屬醫(yī)院婦科住院的妊娠滋養(yǎng)細(xì)胞疾病患者108例,應(yīng)用免疫組化SP法檢測(cè)65例葡萄胎絨毛,36例侵蝕性葡萄胎絨毛,7例絨癌組織及30例(孕周小于12周)正常絨毛中E-粘鈣素表達(dá)強(qiáng)度；(2)對(duì)108例維-漢妊娠滋養(yǎng)細(xì)胞疾病患者的發(fā)病率進(jìn)行統(tǒng)計(jì)分析；65例葡萄胎患者隨訪2年,發(fā)展為侵蝕性葡萄胎和絨癌者13例,對(duì)其妊娠年齡,停經(jīng)時(shí)間,血β-HCG水平等因素進(jìn)行回顧性研究；所有數(shù)據(jù)采用SPSS17.0軟件,等級(jí)資料采用秩和檢驗(yàn),計(jì)數(shù)資料采用卡方檢驗(yàn),檢驗(yàn)水準(zhǔn)取a=0.05,P0.05表示差異有統(tǒng)計(jì)學(xué)意義。結(jié)果：(1)E-粘鈣素在正常早孕絨毛、葡萄胎、侵蝕性葡萄胎以及絨毛膜癌組織中均有表達(dá)(2)4組病例E一鈣粘素表達(dá)強(qiáng)度呈遞減趨勢(shì),經(jīng)兩兩比較正常早孕絨毛和葡萄胎中表達(dá)強(qiáng)度差異有顯著性(P=0.042)；侵蝕性葡萄胎及絨癌表達(dá)強(qiáng)度差異無(wú)顯著性(P=0.514)。(3)108例病例中,漢族63例,發(fā)病率為58.3%；維吾爾族45例,發(fā)病率為41.7%,兩組間比較有統(tǒng)計(jì)學(xué)差異(x2=4.19,P0-05)(4)108例患者,年齡小于23歲者35人,占32.4%;23-35歲者27例,占25.0%；高于35歲者46例,占42.6%,經(jīng)統(tǒng)計(jì)學(xué)處理高于35歲以上者(x2=4.84,P0.05)發(fā)病率較高；(5)65例葡萄胎患者隨訪2年,其中停經(jīng)時(shí)間≥12周者為35例,11例惡變,惡變率31.4%；停經(jīng)時(shí)間12周者為30例,2例惡變,惡變率6.7%。兩組間孕周比較有統(tǒng)計(jì)學(xué)意義(x2=6.19,P0.05)(7)65例葡萄胎患者中血HCG4周轉(zhuǎn)陰者5例,1例惡變,惡變率20%；4～8周轉(zhuǎn)陰者20例,惡變1例,惡變率5%；8周后轉(zhuǎn)陰者40例,惡變11例,惡變率27.5%；血β-HCG水平轉(zhuǎn)陰時(shí)間4周與4-8周兩組無(wú)統(tǒng)計(jì)學(xué)意義(x2=1.20,P0.05)；轉(zhuǎn)陰時(shí)間4周與8周的兩組差異無(wú)統(tǒng)計(jì)學(xué)意義(x2=0.13,P,0.05)。轉(zhuǎn)陰時(shí)間4-8周與8周的兩組差異有統(tǒng)計(jì)學(xué)意義(x2=4.21,P0.05)。結(jié)論：(1)E-粘鈣素在正常絨毛和滋養(yǎng)細(xì)胞絨毛中均有表達(dá),并惡性程度不同,其表達(dá)部位也不同；(2)E-粘鈣素與滋養(yǎng)細(xì)胞的惡性潛能有關(guān)：(3)E-粘鈣素表達(dá)強(qiáng)弱與滋養(yǎng)細(xì)胞惡性程度呈負(fù)相關(guān)；(4)漢族病人患病風(fēng)險(xiǎn)較維吾爾族為高；(5)年齡大于35歲者發(fā)病率較高；(6)停經(jīng)時(shí)間≥12周者較易惡變?yōu)榍治g性葡萄胎；(7)血β-HCG8周轉(zhuǎn)陰者惡變率較高。
[Abstract]:Objective to analyze the expression of E-cadherin in normal early pregnancy villus tissues, hydatidiform mole tissues, invasive hydatidiform mole tissues and choriocarcinoma tissues. To explore the relationship between trophoblastic malignancy and malignant potential of trophoblastic cells. (3) retrospective analysis of the high risk factors of malignant transformation of hydatidiform mole. Methods: 1) selected from March 2008 to March 2013 in the first affiliated Hospital of Xinjiang Medical University. 108 cases of gestational trophoblastic disease hospitalized in gynecology, Immunohistochemical SP method was used to detect the expression intensity of E-mucocalcin in 65 cases of hydatidiform villi and 36 cases of invasive hydatidiform mole villi in 7 cases of choriocarcinoma and 30 cases of normal villi (gestational week < 12 weeks). The incidence of hydatidiform mole was analyzed statistically in 65 patients with hydatidiform mole. Thirteen cases of invasive hydatidiform mole and choriocarcinoma were studied retrospectively, such as gestational age, menopause time and serum 尾 -HCG level, all data were analyzed by SPSS17.0 software, rank sum test was used for grade data, and chi-square test was used for counting data. Results the expression of E-cadherin in normal early pregnancy villi, hydatidiform mole, invasive hydatidiform mole and choriocarcinoma tissues showed a decreasing trend. There was significant difference in expression intensity between normal villus and hydatidiform mole by pairwise comparison, but there was no significant difference in expression intensity between invasive hydatidiform mole and choriocarcinoma, 63 cases were Han nationality, the incidence rate was 58.3%, and 45 cases were Uygur nationality. The incidence rate was 41.7%. There was a statistical difference between the two groups in 4108 patients, 35 of whom were younger than 23 years old (32.4%), 27 cases (25.0%) were aged 32.4 years, 46 cases were over 35 years old. The incidence of hydatidiform mole in 65 patients with hydatidiform mole was higher than that of 35 years old (P 0.05). Among them, 35 cases had malignant change in 35 cases whose menopause time was more than 12 weeks, and 30 cases had malignant change in 30 cases after 12 weeks of menopause. There were significant differences between the two groups in gestational weeks. Among the 65 cases of hydatidiform mole, there were 5 cases of HCG4 turning negative in 5 cases, 20 cases of malignant transformation in 20 ~ 48 weeks, 1 case of malignant change, 40 cases of negative conversion after 58 weeks of malignant change, 11 cases of malignant change. There was no significant difference between the two groups in the conversion time of serum 尾 -HCG between 4 weeks and 4 to 8 weeks (P 0.05), but there was no significant difference between the two groups in the conversion time of 4 weeks and 8 weeks. There was no significant difference between the two groups in the conversion time from 4 weeks to 8 weeks (P 0.05). Conclusion there is significant difference between the two groups in the time of turning negative between 4 and 8 weeks and between the two groups at week 4 to week 8. Conclusion there is no significant difference between the two groups in the time of turning to negative at 4 weeks and 8 weeks. Conclusion there is no significant difference between the two groups. E- mucocalcin was expressed in both normal and trophoblastic villi. And with varying degrees of malignancy, The expression of E-mucocalcin was correlated with the malignant potential of trophoblastic cells. There was a negative correlation between the expression of E-mucocalcin and the malignancy of trophoblastic cells. (4) the risk of disease in Han patients was higher than that in Uygur patients (> 35 years old). Patients with menopause time 鈮，

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