本文選題：宮頸上皮內(nèi)瘤變　切入點(diǎn)：人端粒酶基因(hTERC基因)　出處：《南京大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：通過檢測(cè)經(jīng)組織病理學(xué)診斷為低度宮頸上皮內(nèi)瘤變(CIN1級(jí))患者的宮頸脫落細(xì)胞中的人端粒酶RNA(hTERC基因),并隨訪高危HPV感染的CIN1級(jí)患者2年的疾病專歸及HPV轉(zhuǎn)陰情況。分析人端粒酶RNA與CIN1患者的疾病轉(zhuǎn)歸以及高危HPV轉(zhuǎn)陰率之間的關(guān)系,明確hTERC基因在預(yù)測(cè)宮頸上皮內(nèi)瘤變1級(jí)患者的疾病轉(zhuǎn)歸中的價(jià)值,從而為CIN1級(jí)患者的臨床診治提供參考依據(jù)。方法：選擇2010年1月到2011年4月在南京大學(xué)附屬鼓樓醫(yī)院婦科就診,經(jīng)陰道鏡下活檢病理診斷為CIN1并且均為高危HPV感染的患者118名。用專用保存液及宮頸刷收集每位患者的宮頸脫落細(xì)胞,用熒光原位雜交法檢測(cè)hTERC基因。定期隨訪2年。將實(shí)施宮頸環(huán)形電切術(shù)的56名病人作為手術(shù)組,將未行手術(shù)治療的62名病人作為非手術(shù)組；根據(jù)hTERC檢測(cè)結(jié)果分為hTERC基因陽性組和hTERC基因陰性組(該檢測(cè)結(jié)果在隨訪結(jié)束后揭盲)。所有患者均以宮頸液基細(xì)胞學(xué)檢查(TCT)聯(lián)合高危型HPV(HR-HPV)DNA檢測(cè)(HC-II)作為隨訪的監(jiān)測(cè)方法,每6-12個(gè)月隨訪一次,必要時(shí)行陰道鏡下多點(diǎn)活檢并行病理檢查,以HPV、TCT及組織病理學(xué)診斷相結(jié)合來判定患者的疾病轉(zhuǎn)歸。用SPSS17.0軟件分析數(shù)據(jù),運(yùn)用x 2檢驗(yàn)或FISHER精確檢驗(yàn)法分析hTERC基因與CIN1患者疾病轉(zhuǎn)歸及高危HPV轉(zhuǎn)陰率之間的關(guān)系,并分析宮頸環(huán)形電切手術(shù)在治療CIN1患者中的價(jià)值,評(píng)價(jià)FISH法檢測(cè)hTERC基因在預(yù)測(cè)低度宮頸上皮內(nèi)瘤變患者疾病轉(zhuǎn)歸并且在臨床診治中分流此類患者的應(yīng)用價(jià)值。結(jié)果：1、隨訪24個(gè)月時(shí)共失訪1人,因于外院行物理治療而剔除2人,完成隨訪115人,累積隨訪率為97.46%。2、非手術(shù)組患者在隨訪12個(gè)月及24個(gè)月時(shí),hTERC基因陽性組患者的病變進(jìn)展及持續(xù)比例明顯高于hTERC基因陰性組(P0.05),而hTERC基因陽性組患者的病變逆轉(zhuǎn)比例明顯低于hTERC基因陰性組(P0.05),差異有統(tǒng)計(jì)學(xué)意義。3、手術(shù)組中hTERC基因陽性組和hTERC基因陰性組的患者在隨訪12個(gè)月和24個(gè)月時(shí)疾病的轉(zhuǎn)歸經(jīng)統(tǒng)計(jì)學(xué)計(jì)算無顯著性差異(P0.05)。4、宮頸環(huán)形電切術(shù)可以明顯改善hTERC基因陽性的CIN1患者的預(yù)后(P0.05),但對(duì)hTERC基因陰性的CIN1患者的長(zhǎng)期預(yù)后無明顯的影響(P0.05)。5、非手術(shù)組CIN1患者中hTERC基因陽性組的高危HPV轉(zhuǎn)陰情況明顯低于hTERC基因陰性組(P0.05),差異有統(tǒng)計(jì)學(xué)意義；手術(shù)組患者中hTERC基因陽性組與hTERC基因陰性組的高危HPV轉(zhuǎn)陰情況無顯著性差異(P0.05)。結(jié)論：1、2年內(nèi)hTERC基因陰性的CIN1患者有較高的疾病逆轉(zhuǎn)比例,以及明顯高h(yuǎn)TERC基因陽性CIN1患者的高危HPV轉(zhuǎn)陰率。2、宮頸環(huán)形電切術(shù)可以改善hTERC基因陽性的CIN1患者的預(yù)后,但是對(duì)hTERC基因陰性的CIN1患者的長(zhǎng)期預(yù)后無顯著的作用。3、hTERC基因或許可以作為預(yù)測(cè)CIN1患者的疾病轉(zhuǎn)歸,成為分流CIN1患者的一項(xiàng)生物學(xué)指標(biāo),對(duì)臨床處理低度宮頸上皮內(nèi)瘤變患者有較大的參考價(jià)值。
[Abstract]:Objective: to detect the human telomerase RNA(hTERC gene in cervical exfoliated cells of patients diagnosed by histopathology as low grade cervical intraepithelial neoplasia (cin 1), and to follow up the disease and HPV conversion of CIN1 grade patients with high risk of HPV infection for 2 years. To analyze the relationship between human telomerase RNA and the outcome of CIN1 and the negative rate of high risk HPV. To determine the value of hTERC gene in predicting the outcome of cervical intraepithelial neoplasia grade 1 patients. Methods: from January 2010 to April 2011, Gynaecology of Gulou Hospital, Nanjing University, was selected. The cervical exfoliative cells were collected from 118 patients with CIN1 diagnosed by colposcopy biopsy and all of them with high risk of HPV infection. The hTERC gene was detected by fluorescence in situ hybridization (Fish) and followed up for 2 years. 56 patients undergoing circular electroresection of cervix were selected as the operation group and 62 patients who were not treated by operation as the non-operative group. According to the results of hTERC, they were divided into hTERC gene positive group and hTERC gene negative group. All the patients were followed up by cervical liquid-based cytology combined with high risk HPV(HR-HPV)DNA. The patients were followed up every 6-12 months. If necessary, multipoint biopsy under colposcopy and pathological examination were performed to determine the outcome of the disease by combining HPV-TCT with histopathological diagnosis. The data were analyzed by SPSS17.0 software. The relationship between hTERC gene and disease outcome and high risk HPV negative rate in patients with CIN1 was analyzed by means of x2 test or FISHER accurate test. The value of cervical circular electrotomy in the treatment of CIN1 patients was also analyzed. To evaluate the value of hTERC gene detection by FISH in predicting the outcome of low-grade cervical intraepithelial neoplasia and shunt such patients in clinical diagnosis and treatment. 115 patients were followed up. The cumulative follow-up rate was 97.46.1%. The pathological progression and persistent rate of patients with positive hTERC gene were significantly higher in the non-operative group than in the negative group of hTERC gene at 12 and 24 months, while the proportion of the patients with positive hTERC gene was significantly higher than that of the patients with positive hTERC gene. The difference was statistically significant. There was no significant difference in the prognosis of the patients with hTERC gene positive and hTERC gene negative group after 12 and 24 months follow-up. There was no significant difference in the prognosis of cervix and cervix. Loop electroresection can significantly improve the prognosis of CIN1 patients with hTERC gene positive, but it has no significant effect on the long-term prognosis of CIN1 patients with hTERC gene negative. The high risk HPV negative situation of hTERC gene positive group in non-operative group CIN1 patients is clear. The significant difference was significantly lower than that in hTERC gene negative group (P 0.05). There was no significant difference between the hTERC gene positive group and the hTERC gene negative group in the high risk HPV negative conversion in the operation group (P 0.05). Conclusion there is a higher rate of disease reversal in the CIN1 patients with hTERC gene negative within 1 to 2 years after operation. The high risk HPV negative rate of CIN1 patients with high hTERC gene was significantly higher than that of the patients with high hTERC gene positive. Cervical circular electrotomy could improve the prognosis of CIN1 patients with hTERC gene positive. But it has no significant effect on the long-term prognosis of CIN1 patients with negative hTERC gene. 3hTERC gene may be used as a biological index for predicting the outcome of CIN1 patients and shunt CIN1 patients. It has great reference value for clinical treatment of low grade cervical intraepithelial neoplasia.
【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33

【共引文獻(xiàn)】

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2 林園園;姜艷;侯艷芳;王鷗;李梅;邢小平;董進(jìn);夏維波;;軟骨發(fā)育不全患者的臨床特點(diǎn)及FGFR3基因突變[J];中華骨質(zhì)疏松和骨礦鹽疾病雜志;2015年03期

3 李琳迪;藍(lán)丹;楊湖;許田田;李瓊艷;高宗燕;;軟骨發(fā)育不全與軟骨發(fā)育低下家系的FGFR3基因突變分析[J];臨床兒科雜志;2014年04期

4 伍軍平;羅新;王曉玉;甘丹卉;潘曉婷;;宮頸組織hTERC基因檢測(cè)在宮頸癌篩查中的意義[J];中國(guó)計(jì)劃生育和婦產(chǎn)科;2015年04期

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2 王堯;芯片重測(cè)序技術(shù)檢測(cè)成骨不全基因突變體系的建立及其應(yīng)用[D];山東中醫(yī)藥大學(xué);2014年

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1 周鑫;四種遺傳性骨病的基因診斷與產(chǎn)前診斷[D];南京師范大學(xué);2011年

2 何書勵(lì);1.北京地區(qū)居民2002-2006年髖部骨折發(fā)生率的研究 2.軟骨發(fā)育不全2家系的基因突變研究[D];中國(guó)協(xié)和醫(yī)科大學(xué);2010年

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