本文選題：外陰上皮內(nèi)非瘤樣病變 + 凋亡�。� 參考：《瀘州醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：通過(guò)免疫組化法檢測(cè)凋亡相關(guān)蛋白Bcl-w及Beclin1在外陰上皮內(nèi)非瘤樣病變(nonneoplastic epithelial disorders of vulvar, NNEDV)皮膚組織中的表達(dá)并分析二者相關(guān)性，探討細(xì)胞凋亡是否參與NNEDV發(fā)病過(guò)程，以及凋亡相關(guān)蛋白Bcl-w及Beclin1在NNEDV發(fā)病中可能存在的作用機(jī)制，為NNEDV的臨床診治及進(jìn)一步研究提供實(shí)驗(yàn)依據(jù)。方法：收集因外陰瘙癢行外陰病變部位皮膚活檢術(shù)患者的外陰病變部位（病變組）皮膚組織標(biāo)本，常規(guī)石蠟包埋后切片診斷，篩選出其中經(jīng)病理聯(lián)合臨床綜合確診為外陰上皮內(nèi)非瘤樣病變的皮膚標(biāo)本共42例，其中鱗狀上皮增生型（VSH）20例，硬化苔蘚型（VLS）15例，混合型7例；同時(shí)，收集患者外陰靠近肉眼色素缺失部位的肉眼觀正常的病變旁（病變旁組）皮膚組織標(biāo)本。采用原位末端標(biāo)記（TdT-mediated dUTP Nick-End Labeling, Tunel）細(xì)胞凋亡檢測(cè)試劑盒檢測(cè)各組皮膚上皮細(xì)胞凋亡情況。采用免疫組化法檢測(cè)凋亡相關(guān)蛋白Bcl-w及Beclin1在各組外陰皮膚上皮細(xì)胞中的表達(dá)，，應(yīng)用Image Pro6.0專業(yè)圖像分析系統(tǒng)分析陽(yáng)性細(xì)胞平均光密度（mean optical density, MOD）值，分析二者在各組外陰皮膚上皮細(xì)胞中的表達(dá)差異及相關(guān)性。采用SPSS20.0統(tǒng)計(jì)軟件包處理實(shí)驗(yàn)數(shù)據(jù)，P0.05差異有統(tǒng)計(jì)學(xué)意義。結(jié)果：1、上皮細(xì)胞凋亡指數(shù)（apoptosis index, AI），在VSH與VLS型患者中，病變組均明顯小于病變旁組（P0.05）；在混合型患者中，病變組略小于病變旁組（P0.05）。2、Bcl-w的表達(dá)，在VSH型患者中，病變組明顯高于病變旁組（P0.05）；在VLS型及混合型患者中，病變組與病變旁組間Bcl-w的表達(dá)無(wú)統(tǒng)計(jì)學(xué)差異（P0.05）。3、Beclin1的表達(dá)，在VSH型患者中，病變組明顯低于病變旁組（P0.05）；在VLS型及混合型患者中，病變組與病變旁組間Beclin1的表達(dá)無(wú)統(tǒng)計(jì)學(xué)差異（P0.05）。4、相關(guān)性：Bcl-w與Beclin1的表達(dá)，在VSH型患者病變組（r=0.017, P=0.9440.05）、病變旁組（r=0.101,P=0.6710.05）皮膚組織中均呈不相關(guān)；在VLS型患者病變組呈正相關(guān)(r=0.527, P=0.0430.05)，病變旁組呈不相關(guān)（r=0.472, P=0.0760.05）；在混合型患者病變組（r=-0.070, P=0.8820.05）、病變旁組（r=-0.084,P=0.8590.05）皮膚組織中均呈不相關(guān)。結(jié)論：1、NNEDV三種病理類型患者外陰鱗狀上皮細(xì)胞的凋亡指數(shù)AI病變組均小于病變旁組，表明細(xì)胞凋亡異�？赡苁菂⑴cNNEDV發(fā)生發(fā)展的重要因素之一；同時(shí)，病變組與病變旁組的凋亡指數(shù)相比，在外陰上皮內(nèi)非瘤樣病變VSH型及VLS型患者中差異明顯，而在混合型患者中差異不明顯，提示凋亡異常在NNEDV不同病理類型的形成過(guò)程中發(fā)揮的作用可能存在差異。2、Bcl-w僅在VSH型患者的病變組與病變旁組間的表達(dá)差異明顯，且病變組明顯高于病變旁組，表明Bcl-w參與的抗凋亡作用可能也僅在VSH型病理類型的形成過(guò)程中起重要作用，抗凋亡作用明顯增強(qiáng)，使得病變部位外陰上皮細(xì)胞凋亡減少，增殖能力增強(qiáng)，使得外陰鱗狀上皮增生明顯，參與VSH病理類型的形成。3、Beclin1僅在VSH型患者的病變組與病變旁組間的表達(dá)差異明顯，且在病變組中的表達(dá)低于病變旁組，由此推測(cè)三種病理類型中Beclin1所介導(dǎo)的細(xì)胞自噬性凋亡作用明顯減弱可能僅存在于VSH型病理類型的形成過(guò)程中，從而直接或間接地引起外陰病變部位細(xì)胞凋亡能力減弱，增殖能力相對(duì)增強(qiáng)，從而促使外陰上皮內(nèi)非瘤樣病變VSH型病理類型的發(fā)展形成；而VLS型及混合型病理類型形成過(guò)程中可能不存在Beclin1的細(xì)胞自噬性凋亡作用減弱或減弱作用不明顯，在這兩種病理類型的形成中，Beclin1可能不起重要作用。4、NNEDV三種病理類型中，Bcl-w與Beclin1僅在VLS型患者的病變組呈正相關(guān)，表明Bcl-w與Beclin1可能僅在VLS型病理類型的形成過(guò)程中可能存在相互協(xié)同或促進(jìn)關(guān)系。
[Abstract]:Objective: to detect the expression of apoptosis related protein Bcl-w and Beclin1 in the skin tissues of Nonneoplastic Epithelial Disorders of vulvar, NNEDV by immunohistochemistry and analyze the correlation between the two groups and to explore whether apoptosis participates in the pathogenesis of NNEDV, and the apoptosis related proteins Bcl-w and Beclin1 are in NNEDV. The possible mechanism of action may provide experimental basis for the clinical diagnosis and treatment and further research of NNEDV. Methods: to collect the skin tissue specimens of the vulvar lesions (pathological group) of the patients with vulvar itching in the skin biopsy of the vulvar lesions. A total of 42 skin specimens were diagnosed as non neoplastic lesions of the vulvar epithelium, including 20 cases of squamous epithelial hyperplasia (VSH), 15 cases of lichen Sclerotinia (VLS) and 7 cases of mixed type. At the same time, the skin tissue specimens were collected from the naked eye adjacent to the naked eye, which was near the naked eye pigments. In situ end labeling (TdT-mediated dUT) was used. P Nick-End Labeling, Tunel) cell apoptosis detection kit was used to detect the apoptosis of skin epithelial cells in each group. Immunohistochemical method was used to detect the expression of apoptosis related protein Bcl-w and Beclin1 in the skin epithelial cells of each group, and the Image Pro6.0 professional image analysis system was used to analyze the average optical density of the positive cells (mean optical density). MOD) value, analysis of the expression difference and correlation between the two groups in the vulva skin epithelial cells. The SPSS20.0 statistical package was used to deal with the experimental data. The difference of P0.05 was statistically significant. Results: 1, the epithelial cell apoptosis index (apoptosis index, AI), in the patients with VSH and VLS, the lesion groups were significantly smaller than those in the para pathological group (P0.05); The lesion group was slightly less than the parababal group (P0.05).2, Bcl-w expression, and in VSH patients, the lesion group was significantly higher than that of the parababal group (P0.05). In VLS and mixed patients, the expression of Bcl-w between the lesion group and the parabed group was not statistically different (P0.05).3, the expression of Beclin1, in VSH type patients, was significantly lower than that of the lesion group. Group (P0.05); in patients with type VLS and mixed type, the expression of Beclin1 between the lesion group and the adjacent group had no statistical difference (P0.05).4, correlation: the expression of Bcl-w and Beclin1, in the pathological group of VSH patients (r=0.017, P=0.9440.05), and in the skin tissue of the side group (r=0.101, P=) in the lesion group, Cheng Zhengxiang R=0.527 (P=0.0430.05), the parathal group was unrelated (r=0.472, P=0.0760.05); in the mixed patients (r=-0.070, P=0.8820.05), and in the parathal group (r=-0.084, P=0.8590.05), the skin tissues were not related. Conclusion: 1, the apoptotic index AI lesions in the squamous epithelial cells of the three types of NNEDV are less than those in the lesion group. Group, indicating that abnormal apoptosis may be one of the important factors involved in the development of NNEDV. At the same time, compared with the apoptotic index in the paratunal group, the pathological group is significantly different in the VSH type and VLS type of the non tumor like lesions in the vulvar epithelium, but the difference is not obvious in the mixed type patients, suggesting that the abnormal apoptosis is in the form of different pathological types of NNEDV. There may be differences in the role of.2 in the process of formation, and the difference in expression of Bcl-w only between the patients with VSH type and the parathal group is obvious, and the lesion group is obviously higher than that in the parathal group. It shows that the anti apoptosis effect of Bcl-w may also play an important role in the formation of VSH type, and the anti apoptosis effect is obviously enhanced and the disease is diseased. The apoptosis of the vulvar epithelial cells in the variant part of the vulvar cells was reduced and the proliferation ability was enhanced. The hyperplasia of the squamous epithelium of the vulva was obvious, and it was involved in the formation of.3 in the pathological type of VSH. The expression of Beclin1 was significantly different between the lesion group and the paracathal group of the VSH type, and the expression in the lesion group was lower than that in the parathula group. Therefore, it was suggested that the three pathological types were mediated by Beclin1. The obvious weakening of autophagic apoptosis in the cells may only exist in the formation of VSH type pathological types, which directly or indirectly causes the apoptotic capacity of the cells in the vulvar lesion to be weakened, and the proliferation ability is relatively enhanced, thus promoting the development of the type of VSH type disease in the inner non tumor like lesions of the vulvar epithelium; and VLS and mixed types. The role of Beclin1's autophagic apoptosis may not be weakened or weakened during the formation of pathological types. In the formation of these two types of Pathology, Beclin1 may not play an important role in.4, and in the three pathological types of NNEDV, Bcl-w and Beclin1 are only positively correlated with the group of VLS patients, suggesting that Bcl-w and Beclin1 may be only in the case of Beclin1. There may be synergistic or facilitating relationships in the development of type VLS pathology.

【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33

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