本文選題：孕激素 + 子宮內膜非典型增生　； 參考：《山東大學》2014年碩士論文

【摘要】：[背景]子宮內膜癌(Endometrial Carcinoma, EnCa)是女性生殖器三大惡性腫瘤之一,占女性生殖道惡性腫瘤總數(shù)的20%-30%,占女性惡性腫瘤的7%。從單純內膜增生,到內膜不典型增生,再到高分化內膜癌是一個連續(xù)的病理變化過程。約有30%的侵襲性內膜癌患者由內膜復雜性不典型增生(complex atypical endometrial hyperplasia, CAEH)發(fā)展而來。對于CAEH和EnCa,筋膜外全子宮切除和雙側附件切除仍為主要的治療方法,但手術切除子宮使女性喪失生育功能,因此內膜非典型增生(atypical endometrial hyperplasia, AEH)及早期EnCa的保守治療受到極大的關注,尤其適用于有生育要求的年輕患者。目前常用孕激素治療AEH及早期內膜癌,其有效性得到了證實,但并不是所有患者都得到了完全緩解。如何對患者做出準確的診療決策,尋找到可靠的判斷孕激素保守治療效果的生物學標志物具有重要的病理學意義及臨床意義。 [目的]分析比較孕激素治療子宮內膜復雜性非典型增生(complex atypical endometrial hyperplasia, CAEH)及早期內膜癌(Endometrial Carcinoma, EnCa)的療效差異；研究SPAG9是否可作為判斷CAEH及早期EnCa孕激素治療適宜人群的生物標志物；探討SPAG9是否可用于臨床,輔助判斷孕激素治療子宮內膜病變的有效性,從而輔助做出診療決策。 [方法](1)從山東大學附屬省立醫(yī)院收集2010年到3013年間子宮內膜病變經過孕激素治療的病例(共27例)。此27例病例,均經過大劑量孕激素(250mg-500mg/d)治療,治療前后分別行診斷性刮宮。根據(jù)治療前診斷性刮宮結果分為為非典型增生組(19/27),早期內膜癌組(8/27)；根據(jù)治療前后診斷性刮宮病理結果變化分為治療有效組(21/27)及無效組(6/27)；(2)應用免疫組織化學的方法檢測孕激素治療前后子宮內膜標本中SPAG9的表達情況,對子宮內膜非典型增生組與內膜癌組孕激素治療效果及兩組之間SPAG9的表達情況進行比較；(3)對孕激素治療有效組及無效組分別比較治療前后子宮內膜SPAG9的表達差異。 [結果](1)子宮內膜非典型增生組較內膜癌組孕激素治療前SPAG9表達低,且非典型增生組孕激素治療有效率較內膜癌組高；(2)孕激素治療有效組SPAG9表達顯著下調(有統(tǒng)計學意義),治療無效組SPAG9表達有上調趨勢(無統(tǒng)計學意義)。 [結論]SPAG9表達下調可能與孕激素治療子宮內膜非典型增生(complex atypical endometrial hyperplasia, CAEH)及早期癌的有效性相關。SPAG9的表達可以輔助鑒別AEH與EnCa,并可作為婦產科醫(yī)生判斷孕激素治療適宜患者的生物學標志物。
[Abstract]:Background Endometrial carcinoma (Enca) is one of the three major malignant tumors in female genitalia, accounting for 20-30% of the total number of malignant tumors of female genital tract and 7 cases of female malignant tumors. It is a continuous pathological process from simple intimal hyperplasia to endometrial atypical hyperplasia to highly differentiated endometrial carcinoma. About 30% of invasive endometrial carcinoma patients develop from (complex atypical endometrial hyperplasia, CAEH. For CAEH and Enca, total hysterectomy and bilateral appendage resection are still the main methods of treatment, but surgical hysterectomy makes women lose reproductive function. Therefore, the conservative treatment of endometrial atypical hyperplasia (atypical endometrial hyperplasia, AEH) and early EnCa is of great concern. It is especially suitable for young patients with fertility requirements. The efficacy of progesterone in the treatment of AEH and early endometrial carcinoma has been confirmed, but not all patients have achieved complete remission. How to make accurate diagnosis and treatment decision and find the reliable biomarker to judge the effect of conservative treatment of progesterone has important pathological and clinical significance. [objective] to compare the efficacy of progesterone in the treatment of complex atypical hyperplasia of endometrium (complex atypical endometrial hyperplasia, CAEH) and early endometrial carcinoma (Enca), and to study whether SPAG9 can be used as a biomarker to judge the suitable population for CAEH and early treatment of endometrial carcinoma. To investigate whether SPAG9 can be used in clinic and to evaluate the efficacy of progesterone in the treatment of endometrial lesions. [methods] (1) 27 cases of endometrial lesions treated with progesterone from 2010 to 3013 were collected from Provincial Hospital of Shandong University. All 27 cases were treated with high dose progesterone (250mg-500mg/d) and were treated with diagnostic curettage before and after treatment. According to the results of diagnosis curettage before treatment, they were divided into atypical hyperplasia group (19 / 27), early endometrial carcinoma group (8 / 27), effective treatment group (21 / 27) and ineffective group (6 / 27) according to the pathological changes of diagnostic curettage before and after treatment. (2) Immunohistochemical method was used to detect the expression of SPAG9 in endometrial specimens before and after progesterone treatment, and to compare the effect of progesterone therapy between atypical hyperplasia of endometrium and endometrial carcinoma and the expression of SPAG9 between the two groups. (3) the expression of SPAG9 in endometrium before and after treatment were compared between the effective group and the ineffective group. [results] (1) the expression of SPAG9 in atypical hyperplasia group was lower than that in endometrial carcinoma group, and the effective rate of progesterone therapy in atypical hyperplasia group was higher than that in endometrial carcinoma group. (2) the expression of SPAG9 in the effective group of progesterone treatment was significantly down-regulated (P < 0.05), but the expression of SPAG9 was up-regulated in the ineffective group (no significant difference). [conclusion] the down-regulation of SPAG9 expression may be related to the efficacy of progesterone in the treatment of endometrial atypical hyperplasia (complex atypical endometrial hyperplasia, CAEH) and early stage carcinoma. The expression of SPAG9 may assist in differentiating AEH from EnCa, and can be used as a gynaecologist to determine the appropriate treatment of progesterone. Appropriate biomarkers for patients.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.33

【參考文獻】

相關期刊論文 前1條

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