本文選題：循環(huán)內(nèi)皮細(xì)胞　切入點(diǎn)：腹腔熱灌注化療　出處：《河北大學(xué)》2017年碩士論文

【摘要】：目的:卵巢癌發(fā)病率在全世界女性腫瘤發(fā)病中處在第8位,美國(guó)公布的數(shù)據(jù)約有40%的患者可以獲得治愈,是女性婦科腫瘤相關(guān)死亡率最高的因素。但在我國(guó)大部分的患者初治時(shí)已屬于Ⅲ期,預(yù)后欠佳。目前推薦的治療是腫瘤減滅術(shù)及腹腔熱灌注化療,但此種治療風(fēng)險(xiǎn)較大。循環(huán)內(nèi)皮細(xì)胞(CECs)及活化循環(huán)內(nèi)皮細(xì)胞(VCEC)是存在于外周血中的內(nèi)皮細(xì)胞的一種,有實(shí)驗(yàn)表明其隨腫瘤的進(jìn)展升高,隨有效的治療下降,是預(yù)測(cè)腫瘤效果及預(yù)后的一個(gè)可觀測(cè)的指標(biāo)。本實(shí)驗(yàn)是通過(guò)檢測(cè)外周血中CECs及VCEC數(shù)目評(píng)價(jià)單純卵巢熱灌注化療及聯(lián)合恩度腹腔內(nèi)熱灌注化療的效果及其相關(guān)性。方法:應(yīng)用隨機(jī)方法將39例患者分為兩組,治療組20例聯(lián)合恩度進(jìn)行腹腔熱灌注化療,對(duì)照組19例應(yīng)用單純腹腔熱灌注化療。在治療前及治療后1周抽取外周血應(yīng)用流式細(xì)胞術(shù)檢測(cè)循環(huán)內(nèi)皮細(xì)胞(CECs)及活化循環(huán)內(nèi)皮細(xì)胞(VCEC)。另外于體檢中心抽取健康女性外周血作為陰性對(duì)照。觀察:1)對(duì)照組治療前、治療組治療前及健康人群CECs及VCEC指標(biāo)及差別;2)對(duì)照組與治療組治療后CECs及VCEC指標(biāo)及差別;3)治療組中血性腹水及普通黃綠色腹水治療前后CECs及VCEC差別;4)對(duì)照組及治療組抗腫瘤治療療效及其差異。所有的統(tǒng)計(jì)數(shù)據(jù)及圖表制作均應(yīng)用SPSS 16.0及EXCEL 2010制作;所有的數(shù)據(jù)選擇表示;所有的統(tǒng)計(jì)分析均為雙側(cè)分析,其中P0.05具有統(tǒng)計(jì)學(xué)意義;相關(guān)計(jì)量數(shù)據(jù)符合正態(tài)分布的采用t檢驗(yàn)對(duì)比,有效率的對(duì)比采用卡方檢驗(yàn),采用spearman‘s進(jìn)行相關(guān)性分析。結(jié)果:1.治療前健康組CECs和對(duì)照組有明顯差異(p0.001),治療前健康組CECs結(jié)果和治療組有明顯差異(p0.001);治療組和對(duì)照組差異無(wú)統(tǒng)計(jì)學(xué)意義(p=0.658)。治療前健康組v CEC和對(duì)照組有明顯差異(p0.001),治療前健康組v CEC與治療組有明顯差異(p0.001),治療組和對(duì)照組無(wú)顯著差異(p=0.726)。2.對(duì)照組治療前CECs與治療后對(duì)比,存在差異,治療后CECs水平明顯下降,P0.001。對(duì)照組治療前VCEC與治療后對(duì)比存在差異,P0.001。治療組治療前CECs與治療后對(duì)比,存在差異,P0.001。治療組治療前VCEC與治療后對(duì)比,存在差異,治療后v CEC水平明顯下降,P0.001。3.對(duì)比血性組(2b+3b)與非血性組(3a+2a)治療前CECs及v CEC差別。血性組及非血性組治療前CECs水平符合正態(tài)分布檢驗(yàn),采用兩樣本Student's t test,P值=0.0110.05,差異有統(tǒng)計(jì)學(xué)意義。血性組及非血性組治療前VCEC水平對(duì)比,P=0.0830.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。4.治療組RR率80%;對(duì)照組RR率78.9%,采用卡方檢驗(yàn)比較治療組及對(duì)照組有效率,P=0.716,無(wú)統(tǒng)計(jì)學(xué)差異。2a組治療前后CECs與2b組治療前后CECs對(duì)比,采用配對(duì)T檢驗(yàn),P=0.010.05,差異有統(tǒng)計(jì)學(xué)意義。2a組治療前后v CEC與2b組治療前后v CEC下降對(duì)比采用配對(duì)T檢驗(yàn),P值=0.0470.05,差異有統(tǒng)計(jì)學(xué)意義。3a組治療前后及3b治療前后CECs下降對(duì)比采用方差不齊配對(duì)T檢驗(yàn),P=0.3880.05,差異無(wú)統(tǒng)計(jì)學(xué)意義,兩組CECs水平下降無(wú)差異。3a組治療前后及3b組治療前、后v CEC下降對(duì)比采用配對(duì)T檢驗(yàn),P=0.3030.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。5.治療前CECs水平與治療效果相關(guān)性的研究采用spearman‘s相關(guān)分析,相關(guān)系數(shù)rs=-0.170,P=0.300,無(wú)統(tǒng)計(jì)學(xué)意義,無(wú)相關(guān)性。治療前VCEC水平與治療效果相關(guān)性的研究采用spearman‘s相關(guān)分析,相關(guān)系數(shù)rs=-0.471,P=0.003,有統(tǒng)計(jì)學(xué)意義,呈負(fù)相關(guān)。結(jié)論:1.循環(huán)內(nèi)皮細(xì)胞是觀察卵巢癌伴有惡性腹腔積液患者腹水控制的一個(gè)潛在的指標(biāo)。2.腹腔熱灌注治療及恩度聯(lián)合腹腔熱灌注治療是治療卵巢合并腹腔積液一個(gè)有效的措施。3.恩度聯(lián)合腹腔熱灌注化療有提高腹腔熱灌注化療有效率的趨勢(shì),無(wú)統(tǒng)計(jì)學(xué)意義。4.恩度針對(duì)血性腹腔積液效果更好,可以得到更好的控制。5.VCEC水平與卵巢癌合并腹腔積液的患者治療效果呈負(fù)相關(guān)。
[Abstract]:Objective: the incidence of ovarian cancer in the pathogenesis of cancer in women around the world in eighth, the United States released data about 40% of patients can be cured, is female gynecological tumor associated with the highest mortality rate in our country. But most of the patients are stage III, good prognosis owe the recommended treatment is at present. Cytoreductive surgery and intraperitoneal hyperthermic perfusion chemotherapy, but the treatment of high risk. The circulating endothelial cells (CECs) and activation of circulating endothelial cells (VCEC) is a present in the peripheral blood endothelial cells, experiments have shown that with the progression of the tumor increased, with the decline of effective treatment, is a the observed index prediction of tumor and prognosis. This experiment is through the number of CECs and VCEC detection in the peripheral blood of IPHP simple ovarian perfusion chemotherapy and evaluate the effect of Endostar and correlation. Methods: using random method 39 patients were divided into two groups, 20 cases in the treatment group combined with Endostar hyperthermic intraperitoneal chemotherapy, 19 cases in the control group used simple peritoneal perfusion chemotherapy. In 1 weeks before and after treatment from peripheral blood flow cytometry was used to detect circulating endothelial cells (CECs) and activation of circulating endothelial cells (VCEC in addition to the physical examination center.) from peripheral blood of healthy women as negative control. Observe: 1) control group before treatment, the treatment group before treatment and healthy population CECs and VCEC index and difference; 2) the control group and the treatment group after the treatment of CECs and VCEC index and difference; 3) in the treatment group before and after hemorrhagic ascites and ordinary yellow green CECs and VCEC differential treatment of ascites; 4) group and treatment group curative effect of anti-tumor therapy and the difference of control. All of the statistical data and charts are used in SPSS 16 and EXCEL 2010; all data representation; all statistical analyses were two-sided analysis P0.05, which has statistical significance; the relevant measurement data with normal distribution by t test comparison, comparing the efficiency of using the chi square test, using Spearman 's correlation analysis. Results: 1. healthy before treatment group CECs and control group had significant difference (p0.001) before treatment, CECs treatment group and healthy group results there was significant difference (p0.001); the treatment group and the control group had no significant difference (p=0.658) before treatment. V healthy group CEC and control group had significant difference (p0.001), V CEC health group before treatment and the treatment group had significant difference (p0.001), there was no significant difference between the treatment group and the control group (p=0.726.2.) the control group before treatment and after treatment CECs comparison, there are differences, the level of CECs decreased significantly after treatment, P0.001. group before treatment and after treatment of the existence of differences between VCEC, P0.001. treatment group before and after treatment CECs comparison, differences in P0.001. treatment group Compared with before treatment, after the treatment with VCEC differences, V CEC levels were significantly decreased after treatment, compared with P0.001.3. group (2b+3b) and non hemorrhagic hemorrhagic group (3a+2a) and V CEC CECs before treatment difference. Hemorrhagic group and non hemorrhagic group CECs level before treatment with normal distribution test, using two sample Student's t test. P =0.0110.05, the difference was statistically significant. Blood group and non hemorrhagic group comparison, VCEC level before P=0.0830.05, there was no significant difference between.4. treatment group RR was 80%; the control group was 78.9% RR, using chi square test to compare the efficiency of the treatment group and the control group, P= 0.716, no significant difference between the groups before and after treatment before and after.2a CECs and CECs in 2B group compared with paired T test, P=0.010.05, the difference has statistical significance before and after treatment in group.2a and group 2B before and after V CEC treatment of V CEC decreased compared with paired T test, P value =0.0470.05, the difference has statistical significance before and after treatment in group.3a Before and after treatment of CECs and 3b decreased compared with the homogeneity of variance paired T test, P=0.3880.05, no significant difference between the CECs levels of the two groups decreased there was no difference between group.3a and group 3B before and after treatment before treatment, after V CEC decreased compared with paired T test, P=0.3030.05, of no significant difference between the level of CECs before and.5. treatment. Effect of treatment with Spearman 's correlation analysis, correlation coefficient rs=-0.170, P=0.300, no statistical significance, no correlation. The VCEC level before treatment and treatment effect of correlation with Spearman' s correlation analysis, correlation coefficient rs=-0.471, P=0.003, a statistically significant negative correlation. Conclusion: 1. circulating endothelial cells is observed in the ovary carcinoma with malignant ascites in patients with ascites control is a potential indicator of.2. intraperitoneal hyperthermic perfusion treatment and Endostar combined with intraperitoneal hyperthermic perfusion therapy is a treatment of ovarian complicated with ascites .3. Endostar combined with intraperitoneal hyperthermic perfusion chemotherapy is effective to improve the efficiency of peritoneal perfusion chemotherapy trend, no significant.4. for better effect of Endostar bloody peritoneal effusion, was negatively related to treatment effect can get better control the level of.5.VCEC and ovarian cancer with ascites.

【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.31

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