本文選題：氣胸　切入點(diǎn)：女性　出處：《東南大學(xué)》2016年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：自發(fā)性氣胸(spontaneous pneumothorax, SP)性別差異明顯,通過(guò)臨床工作,病歷資料分析及實(shí)驗(yàn)室檢查,分析女性SP患者肺大皰標(biāo)本雌激素受體(estrogen receptor, ER)、孕激素受體(progesterone receptor, PR)、CD 10的表達(dá)和FLCN (folliculin)的基因突變,歸納女性SP患者的臨床特點(diǎn),為女性SP臨床個(gè)體化診治提供借鑒和指導(dǎo)。方法：回顧性分析東南大學(xué)附屬南京市胸科醫(yī)院2011年01月至2015年06月834例(其中男738例,女96例)臨床診斷SP患者的臨床資料；包括患者發(fā)病年齡,既往史,重點(diǎn)了解是否存在氣胸家族發(fā)病、皮膚損害、腎臟腫瘤、慢性阻塞性肺病(chronic obstructive pulmonary disease, COPD)、肺結(jié)核(pulmonary tuberculosis)等,肺大皰(pulmonary bullae)發(fā)生的側(cè)別、位置、大小、形態(tài),術(shù)中探查所見(jiàn)肺大皰分布位置,術(shù)后置管及住院時(shí)間。選取34例女性SP患者手術(shù)切除標(biāo)本行免疫組化染色評(píng)分,評(píng)估肺組織中雌激素受體、孕激素受體及CD10的表達(dá)強(qiáng)度。對(duì)217例(其中男192例,女25例)有家族史或高度懷疑BHD綜合征的患者行外周血FLCN基因突變檢測(cè)。結(jié)果：①女性患者發(fā)病年齡存在兩個(gè)高峰,分別在15-30歲和40-60歲。平均年齡在性別上無(wú)差異(P0.05)。②女性患者中原發(fā)性自發(fā)性氣胸(PSP)組的發(fā)病年齡明顯低于繼發(fā)性自發(fā)性氣胸(SSP)組(P0.05)。③PSP組與SSP組的術(shù)后置管時(shí)間無(wú)差異(P0.05)。④PSP組的術(shù)后住院天數(shù)明顯短于SSP組(P0.05)。⑤PSP組位于肺尖部的肺大皰所占比例要高于SSP組(P0.05)。⑥女性SP患者肺大皰切除標(biāo)本中,ER的陽(yáng)性率為97.06%(33/34),PR的陽(yáng)性率為67.65%(23/34),CD10的陽(yáng)性率為70.59%(24/34)。⑦ FLCN基因突變率,女性32.00%(8/25),男性9.90%(19/192),女性明顯高于男性(P0.05)。結(jié)論：①對(duì)于自發(fā)性氣胸的育齡期婦女,應(yīng)考慮月經(jīng)性氣胸的可能,并依據(jù)其臨床特點(diǎn),借助輔助檢查及內(nèi)鏡探查手段,特別是病理檢測(cè)、免疫組化的鑒定,盡早明確診斷,予以合理治療。②女性患者FLCN基因突變率明顯高于男性患者,FLCN基因突變可能是女性PSP的主要致病因素之一。
[Abstract]:Objective: the sex difference of spontanous pneumothorax (SPI) in spontaneous pneumothorax (SPV) was significant. To analyze the expression of estrogen receptor (ERG), estrogen receptor (ERT), progesterone receptor (PR10), progesterone receptor (PR10) and FLCN folliculin gene mutation in female patients with SP, the clinical features of female SP patients were summarized. Methods: the clinical data of 834 patients (738 males and 96 females) in Nanjing chest Hospital affiliated to Southeast University from January 2011 to June 2015 were analyzed retrospectively. Including the patient's onset age, past history, emphasis on the presence of pneumothorax family disease, skin damage, kidney tumor, chronic obstructive pulmonary disease (Copd, pulmonary tuberculosis tuberculosis), and the side, location, size and shape of pulmonary bullae. The location of pulmonary bullous distribution, postoperative catheterization and hospitalization time were explored during operation. 34 female patients with SP were selected for immunohistochemical staining to evaluate the estrogen receptor in lung tissue. The expression of progesterone receptor and CD10 was detected in 217 patients (192 males and 25 females) with family history or highly suspected BHD syndrome. The age of onset of primary spontaneous pneumothorax in female patients with primary spontaneous pneumothorax was significantly lower than that in secondary spontaneous pneumothorax group (P 0.05). 3PSP group and SSP group had no difference in postoperative catheterization time. The postoperative hospitalization days in the P0.05PSP group were significantly shorter than those in the SSP group (P 0.05N 路5PSP group). The proportion of pulmonary bullae located at the tip of the lung in the P0.05PSP group was significantly higher than that in the female patients with pulmonary bullous excision in the SSP group. The positive rate of ER was 97.06% 33% 34 PR. The positive rate of CD10 was 70.5924% 34.7 FLCN gene mutation. Women 32.00 / 25, men 9.90 / 1922, women significantly higher than men P0.05.Conclusion for women of childbearing age with spontaneous pneumothorax, the possibility of menstrual pneumothorax should be considered, and according to its clinical characteristics, with the aid of auxiliary examination and endoscopic exploration, especially pathological examination, it is necessary to consider the possibility of menstrual pneumothorax in women with spontaneous pneumothorax. Immunohistochemical identification, early diagnosis and reasonable treatment of FLCN gene mutation in female patients were significantly higher than those in male patients, which may be one of the main pathogenetic factors of female PSP.
【學(xué)位授予單位】：東南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R561.4

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