本文選題：外陰白色病變　切入點(diǎn)：綜合療法　出處：《吉林大學(xué)》2014年碩士論文

【摘要】：目的：1.研究綜合療法治療外陰白色病變的臨床療效。2.檢測綜合療法治療前后外陰白色病變組織中血管內(nèi)皮生長因子（VEGF）和人原始造血細(xì)胞抗原（CD34）的表達(dá)意義及相關(guān)性研究，近一步探討外陰白色病變的病因及發(fā)病機(jī)制,為臨床治療提供理論依據(jù)。 方法：搜集2011年1月至2012年6月來我院婦科門診就診的外陰白色病變患者62例，于陰道鏡下病變明顯處取外陰病理活檢確診，其中鱗狀上皮增生（SH）32例，硬化性苔蘚（LS）30例，并行免疫組化檢測病變組織中VEGF、CD34的表達(dá)，對CD34染色陽性的微血管進(jìn)行計(jì)數(shù)[微血管密度(MVD,micro vessel density)]。62例患者病變區(qū)域用重組人表皮生長因子凝膠、重組人IFNα-2b凝膠、雌三醇軟膏藥物局部治療，并根據(jù)病情輕重，于治療的第1、3、6個(gè)月、1年按評價(jià)標(biāo)準(zhǔn)判定臨床療效及治療后改變，治療結(jié)束后，于外陰原病變處再次取活檢行病理學(xué)檢查及免疫組化研究。比較外陰白色病變組織中VEGF、CD34治療前后的表達(dá)情況。10例正常的外陰組織作為對照。 結(jié)果：1.綜合治療前后瘙癢、彈性、顏色差異均具有統(tǒng)計(jì)學(xué)意義（P0.05），治療后外陰瘙癢、皮膚色澤、彈性等均有大幅度改善，總有效率達(dá)95.16%,外陰硬化性苔蘚（LS組）、外陰鱗狀上皮增生（SH組）治療的總有效率進(jìn)行比較，差異無統(tǒng)計(jì)學(xué)意義（P0.05）。2.治療前：外陰硬化性苔蘚（LS組）的VEGF的表達(dá)和微血管數(shù)目（MVD值）均低于正常外陰皮膚組，差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)，與外陰鱗狀上皮增生（SH組）相比差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)；外陰鱗狀上皮增生（SH組）VEGF的表達(dá)和微血管數(shù)目（MVD值）與正常外陰組織相比差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)；在LS中VEGF的表達(dá)與MVD計(jì)數(shù)存在正相關(guān)。治療后：LS組、SH中VEGF、MVD與正常外陰皮膚組相比差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)，，LS組與SH組相比差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)。治療前后LS中VEGF、MVD相比差異有統(tǒng)計(jì)學(xué)意義（P＜0.05)；治療前后SH組中VEGF、MVD相比差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)。 結(jié)論：1.本研究證實(shí)綜合療法（重組人表皮生長因子凝膠、重組人IFNα-2b凝膠、雌三醇軟膏）對不同組織病理類型的外陰白色病變具有顯著治療效果。 2.外陰硬化性苔蘚組織中VEGF的表達(dá)減少，微血管數(shù)目減少；外陰鱗狀上皮增生組織中VEGF的表達(dá)和微血管數(shù)目無明顯改變，微血管結(jié)構(gòu)功能障礙，與外陰白色病變有相關(guān)性。 3.經(jīng)綜合治療后，微血管數(shù)目及形態(tài)功能得到明顯改善。提示真皮層微循環(huán)障礙引起局部營養(yǎng)代謝障礙與外陰白色病變有相關(guān)性。
[Abstract]:Objective 1. To study the clinical efficacy of combined therapy in the treatment of vulvar white lesions. 2. To detect the expression of vascular endothelial growth factor (VEGF) and human primitive hematopoietic antigen (CD34) in vulvar white lesions before and after treatment. To explore the etiology and pathogenesis of vulvar white lesions and provide theoretical basis for clinical treatment. Methods: from January 2011 to June 2012, 62 cases of vulvar white lesions were collected from gynecological outpatient clinic of our hospital. The pathological biopsy of vulva was performed under colposcopy, including 32 cases of squamous epithelium hyperplasia and 30 cases of sclerosing lichen sclerosus. The expression of VEGF CD34 was detected by immunohistochemistry. The microvessels with positive CD34 staining were counted. 62 patients were treated with recombinant human epidermal growth factor gel and recombinant human IFN 偽 -2b gel. Local treatment of estriol ointment, and according to the severity of the disease, according to the 1st month, 6 months, 1 year according to the evaluation criteria to determine the clinical efficacy and changes after treatment, after the end of treatment, The expression of VEGF CD34 in white lesions of vulva was compared before and after treatment. 10 cases of normal vulvar tissues were used as control. Results 1. There were statistically significant differences in pruritus, elasticity and color before and after comprehensive treatment. After treatment, the pruritus of vulva, skin color and elasticity were greatly improved. The total effective rate was 95.16. The total effective rate was compared between the LS group of vulva lichen sclerosus and the SH group of vulvar squamous epithelium hyperplasia. Before treatment, the expression of VEGF and the number of microvessels in LS group were lower than those in normal vulvar skin group. The difference was statistically significant (P < 0.05, compared with the vulvar squamous epithelium hyperplasia group) (P < 0.05), the expression of VEGF and the number of microvessels in the vulvar squamous epithelium hyperplasia group were not significantly different from those in the normal vulvar tissue (P < 0.05), and there was no significant difference in the expression of VEGF and the number of microvessel and MVD between the vulvar squamous epithelium hyperplasia group and the normal vulvar tissue group. The expression of VEGF in LS was positively correlated with the count of MVD. After treatment, there was no significant difference in VEGF and MVD between the two groups (P > 0.05), and there was no significant difference between the two groups before and after treatment (P > 0.05), and there was no significant difference between the two groups before and after treatment (P > 0.05), and before and after treatment, there was no significant difference in VEGFMVD between the two groups (P > 0.05), and there was no significant difference between the two groups before and after treatment (P > 0.05). There was no significant difference in VEGF MVD in SH group before and after treatment (P > 0.05). Conclusion [WT5HZ] this study demonstrated that the combined therapy (recombinant human epidermal growth factor gel, recombinant human IFN 偽 -2b gel, estriol ointment) had a significant therapeutic effect on the white lesions of vulva with different histopathological types. 2. The expression of VEGF in vulvar lichen sclerosus decreased and the number of microvessels decreased, while the expression of VEGF and the number of microvessels in vulvar squamous epithelium hyperplasia did not change obviously. The dysfunction of microvessel structure and function was related to the white lesion of vulva. 3. After comprehensive treatment, the number and morphological function of microvessels were improved obviously, which suggested that the local nutritional disorders caused by dermis microcirculation disorder were related to the white lesions of vulva.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R711.72

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