【摘要】：目的：本研究主要通過檢測(cè)宮頸癌及癌前病變組織中的DNA倍體狀態(tài)來探討DNA異倍體細(xì)胞在宮頸病變發(fā)生發(fā)展過程中的生物學(xué)特性，進(jìn)而預(yù)測(cè)宮頸病變的發(fā)展趨勢(shì)，為臨床診斷及處理提供依據(jù)。 方法：收集2013年3月-2014年2月河北醫(yī)科大學(xué)第二醫(yī)院婦科門診及住院患者的385例液基細(xì)胞學(xué)剩余標(biāo)本進(jìn)行DNA倍體分析，以組織病理學(xué)結(jié)果作為診斷的金標(biāo)準(zhǔn)。臨床表現(xiàn)為白帶增多（無臨床癥狀因體檢時(shí)發(fā)現(xiàn)宮頸病變）、性交后出血、絕經(jīng)后出血、不規(guī)則陰道流血、流液（米泔樣，伴惡臭味）、腹疼等癥狀者和宮頸糜爛者。 結(jié)果：共于我院婦科實(shí)驗(yàn)室收集液基細(xì)胞學(xué)剩余標(biāo)本385例進(jìn)行DNA倍體分析。其中包括：液基薄層細(xì)胞診斷為ASCUS的剩余標(biāo)本310例，LSIL標(biāo)本73例，住院病人最終病理結(jié)果為腺癌的2例液基細(xì)胞學(xué)保存標(biāo)本。383例液基細(xì)胞學(xué)診斷為ASCUS及LSIL的標(biāo)本均搜集到了組織病理學(xué)結(jié)果，CIN以上病變141例（36.81%）。其中CIN I71例（50.35%），CIN II20例（14.18%）,CIN III36例（25.53%），宮頸癌14例（9.93%）。DNA倍體分析可見DNA異倍體細(xì)胞233例（DNA異倍體細(xì)胞陽性）陽性率60.84%，未見DNA異倍體細(xì)胞150例（DNA異倍體細(xì)胞陰性）。宮頸脫落細(xì)胞的DNA異倍體細(xì)胞數(shù)1-2個(gè)83例，病理結(jié)果證實(shí)為高級(jí)別宮頸病變7例，陽性檢出率為8.43%。異倍體細(xì)胞3-9個(gè)80例,高級(jí)別宮頸病變17例，陽性檢出率為21.25%。異倍體細(xì)胞≥10個(gè)有70例,高級(jí)別宮頸病變44例，陽性檢出率為62.86%。兩兩比較差異均有統(tǒng)計(jì)學(xué)意義。若以DNA指數(shù)2.5的3個(gè)或超過3個(gè)異倍體細(xì)胞定位為篩查后需作活檢的標(biāo)準(zhǔn)，CINII以上病變的敏感性、特異性、陰性預(yù)測(cè)值分別為89.71%、46.06%、91.57%。若以DNA指數(shù)2.5的1個(gè)或超過1個(gè)異倍體細(xì)胞（異倍體細(xì)胞陽性）定位為篩查后需作活檢的標(biāo)準(zhǔn)，CINII以上病變的敏感性、特異性、陰性預(yù)測(cè)值分別為97.14%、47.28%、98.67%。且DNA異倍體細(xì)胞陰性及陽性者發(fā)生宮頸病變的例數(shù)比較差異有統(tǒng)計(jì)學(xué)意義（χ2=118.823，P0.01）。在310例ASCUS患者中隨訪到211例HPV檢測(cè)結(jié)果，其中高危型HPV陽性152例，高危型HPV陰性患者59例。在高危型HPV陽性組中：DNA異倍體細(xì)胞陰性者67例，病理結(jié)果檢測(cè)出CINIII1例。DNA異倍體細(xì)胞陽性者85例，，病理結(jié)果提示CINII13例，CINIII15例，宮頸癌9例。在高危型HPV檢測(cè)陰性組中：DNA異倍體細(xì)胞陰性者26例，病理結(jié)果提示CINIII1例。DNA異倍體細(xì)胞陽性者33例，病理結(jié)果提示CINII5例，CINIII4例。在高危型HPV陽性組中，DNA異倍體細(xì)胞陰性、陽性者中高級(jí)別宮頸病變的病理結(jié)果比較差異有統(tǒng)計(jì)學(xué)意義（χ2=35.311P0.01）。在高危型HPV陰性組中，DNA異倍體細(xì)胞陰性、陽性者中高級(jí)別宮頸病變的病理結(jié)果比較差異有統(tǒng)計(jì)學(xué)意義（χ2=4.128P0.05）。 結(jié)論：宮頸脫落細(xì)胞的DNA定量分析作為一種行之有效的方法已應(yīng)用于腫瘤病理分析及臨床診斷研究中。能使臨床病理醫(yī)師較為客觀的對(duì)每個(gè)細(xì)胞核的DNA含量進(jìn)行檢測(cè)，受細(xì)胞自身蛻變的影響較小，在臨床檢測(cè)中具有較高的敏感性及陰性預(yù)測(cè)值。標(biāo)準(zhǔn)化的DNA倍體分析儀以更高的質(zhì)量評(píng)估腫瘤的良惡性，進(jìn)而為臨床診斷提供客觀準(zhǔn)確的分析結(jié)果。
[Abstract]:Objective: To study the biological characteristics of DNA heteroploid cells in the development of cervical lesions, and to predict the development trend of cervical lesions, and to provide the basis for clinical diagnosis and treatment. Methods: 385 cases of liquid-based cytology in the second hospital of Hebei Medical University from March, 2013 to February, 2014 were collected for DNA ploidy analysis, and the pathological results were used as gold for diagnosis. Standard. The clinical manifestation is the increase of leucorrhea (no clinical symptoms found in the cervical lesion due to physical examination), post-sexual hemorrhage, post-menopausal bleeding, irregular vaginal bleeding, fluid (misty, with bad smell), abdominal pain, and the like Results: The total of 385 cases of the remaining specimens of the liquid-based cytology in the gynecology laboratory of our hospital were DN. A-fold analysis was performed, including: the diagnosis of liquid-based thin-layer cells as the remaining specimens of ASUS, 73 cases of LSIL, and 2 liquid-based cytology samples of the in-patient final pathological results. 383 cases of liquid-based cytology were collected in the specimens of ASUS and LSIL. Pathological findings, 141 cases of above CIN (36. 81%). Of these, CIN I71 (50. 35%), CIN II20 (14. 18%), CIN III36 (25. 53%), and cervical cancer 14 (9.93%). Cell negative). The number of DNA heteroploid cells of cervical exfoliated cells was 1-2, and the pathological results were confirmed to be 7 cases of high-grade cervical lesions. The positive rate of positive rate was as follows: 8. 43%. 3-9, 80 and 17 high-level cervical lesions. The positive rate of positive rate was 2. 1. 25%. There were 70 cases of heteroploid somatic cell and 44 cases of high-grade cervical lesions. The positive rate of positive rate was 6. 2.86% and 2.86% respectively. Statistical significance. The sensitivity, specificity and negative predictive value of CINII lesions were 89. 71%, 46. 06%, 9, respectively, in the case of 3 or more than 3 heteroploid somatic cells with a DNA index of 2.2. 5 as the standard for biopsy. 1. 57%. The sensitivity, specificity and negative predictive value of CINII lesions were 97. 14%, 47. 28%, 9, respectively, if 1 or more of the heteroploid cells (heteroploid cell positive) were located in the DNA index of 2.5. 5 as the standard for biopsy, and the sensitivity, specificity and negative predictive value of the CINII lesions were 97,14%, 47. 28%, 9, respectively. There was a significant difference in the number of cervical lesions in the negative and positive cases of DNA heteroploid cell negative and positive (Sup2 = 118. 823, P 0. 01). Follow-up to 211 cases of HPV testing in 310 ASUS patients, including 152 high-risk HPV positive, high-risk HPV negative 59 of the patients. In the high-risk HPV-positive group, 67 cases of DNA heteroploid cell-negative were detected and CIN was detected by the pathological results. In III1 cases, 85 cases of DNA heteroploid cell were positive, and the pathological results suggested that CINII13 and CINIII15 cases were positive. 9 cases of cervical cancer. In the negative group of high-risk HPV, 26 cases were negative, and the pathological results suggested that CIN III1 cases. 33 cases of DNA heteroploid cell were positive, and the pathological findings suggested that CINII 5 cases, CIN III4. In the high-risk HPV-positive group, there was a statistically significant difference in the pathological findings of the high-grade non-cervical lesions in the positive and positive cases (Sup2 = 35. 311P 0. 01). In the high-risk HPV-negative group, the DNA heteroploid cell was negative, and the pathological results of the high-grade cervical lesions in the positive-positive case were statistically significant (Sup2 = 4.128P Conclusion: The DNA quantitative analysis of cervical exfoliated cells has been applied to the pathological analysis of the tumor. and has high sensitivity in clinical detection. The standardized DNA ploidy analyzer is used for evaluating the good and malignant of the tumor with higher quality, and further provides a passenger for clinical diagnosis
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R711.74

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