本文選題：子宮內(nèi)膜癌 + 子宮內(nèi)膜樣腺癌�。� 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:子宮內(nèi)膜癌(Endometrial Carcinoma,EC)是一種上皮性惡性腫瘤,發(fā)生于子宮內(nèi)膜,是女性生殖道三大惡性腫瘤之一[1],其在女性全身的惡性腫瘤中所占的比例為7%,在女性生殖道惡性腫瘤中所占的比例為20%-30%,其中來(lái)源于子宮內(nèi)膜腺體的腺癌是最常見(jiàn)的類型,在經(jīng)濟(jì)發(fā)達(dá)的國(guó)家及我國(guó)部分經(jīng)濟(jì)發(fā)達(dá)的城市,EC的發(fā)病率在婦科惡性腫瘤中的排名已經(jīng)位居第一,目前其發(fā)病率在全球范圍內(nèi)有逐漸上升的趨勢(shì)[2],目前EC及癌前期病變年輕化趨勢(shì)明顯,未生育女性的發(fā)病率較前有所增加,但至今為止,其發(fā)病機(jī)制仍沒(méi)有完全明確[3],在目前臨床上所有的觀點(diǎn)中,較為認(rèn)同的是“無(wú)抵抗雌激素”學(xué)說(shuō)。根據(jù)其發(fā)病中對(duì)于雌激素的依賴與否可以分為兩型:雌激素依賴型(Ⅰ型)和非雌激素依賴型(Ⅱ型)兩種,雌激素依賴型在EC中占大多數(shù),均為子宮內(nèi)膜樣腺癌,患者相對(duì)來(lái)說(shuō)通常比較年輕,而且常伴有肥胖、高血壓、糖尿病、不孕或不育及絕經(jīng)延遲[4]。Ⅱ型的病理形態(tài)相對(duì)少見(jiàn),該型內(nèi)膜癌的特點(diǎn)是多見(jiàn)于老年體瘦婦女,至今為止尚未找到明確的發(fā)病原因。環(huán)氧合酶-2(Cyclooxygenase-2,COX-2)是一種誘導(dǎo)性轉(zhuǎn)錄酶,在正常的生理狀況下機(jī)體是檢測(cè)不到的,但高表達(dá)于多種惡性腫瘤組織,近期研究發(fā)現(xiàn),COX-2在某些腫瘤的細(xì)胞增殖、抗凋亡和血管生成等過(guò)程中發(fā)揮一定的作用,與腫瘤的發(fā)生、發(fā)展以及預(yù)后密切相關(guān)[5]。傳統(tǒng)認(rèn)為,Ⅰ型EC與神經(jīng)內(nèi)分泌密切相關(guān),僅有少量的內(nèi)分泌細(xì)胞(Endocrine Cell)存在于正常的子宮內(nèi)膜中,而在子宮內(nèi)膜樣腺癌組織中卻比較多見(jiàn)內(nèi)分泌細(xì)胞,至今為止,仍不能明確這些內(nèi)分泌細(xì)胞出現(xiàn)的意義及其與EC生物學(xué)行為的關(guān)系。嗜鉻粒蛋白A(Chromogranin A,Cg A)是神經(jīng)內(nèi)分泌較特異性的標(biāo)志物。本研究通過(guò)檢測(cè)COX-2、Cg A在Ⅰ型EC及正常子宮內(nèi)膜組織中的表達(dá)情況,探討兩者在子宮內(nèi)膜樣腺癌的發(fā)生、發(fā)展中的作用,同時(shí)探討兩者在子宮內(nèi)膜樣腺癌的發(fā)生、發(fā)展過(guò)程中的相互關(guān)系,評(píng)估子宮內(nèi)膜樣腺癌的預(yù)后及為指導(dǎo)子宮內(nèi)膜樣腺癌的治療開(kāi)拓新的臨床路徑。方法:1本實(shí)驗(yàn)擇取2014年5月~2016年8月于河北省人民醫(yī)院婦科行手術(shù)治療的EC患者52例,其術(shù)后送檢切除的子宮,病理結(jié)果均是子宮內(nèi)膜樣腺癌,將子宮內(nèi)膜樣腺癌的標(biāo)本作為實(shí)驗(yàn)組。選取同期因子宮或卵巢的良性病變給予全子宮切除的患者22例作為對(duì)照組,并且其術(shù)后病理結(jié)果回報(bào)為正常子宮內(nèi)膜。2采用免疫組化法(SP法)檢測(cè)52例子宮內(nèi)膜樣腺癌及22例正常子宮內(nèi)膜的石蠟切片中的COX-2、Cg A的表達(dá)情況。3分析COX-2、Cg A蛋白的表達(dá)與子宮內(nèi)膜樣腺癌各臨床病理特征之間的關(guān)系。4采用SPSS17.0統(tǒng)計(jì)學(xué)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析及處理,P0.05具有統(tǒng)計(jì)學(xué)意義。5 Spearman相關(guān)檢驗(yàn)分析二者在子宮內(nèi)膜樣腺癌組織中表達(dá)的關(guān)系。結(jié)果:1 COX-2在正常的子宮內(nèi)膜組織中的陽(yáng)性表達(dá)率為36.36%,在子宮內(nèi)膜樣腺癌組織中的陽(yáng)性表達(dá)率為80.77%。子宮內(nèi)膜樣腺癌組的COX-2的表達(dá)率較正常子宮內(nèi)膜組的表達(dá)率要高,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.01)。COX-2的表達(dá)與子宮內(nèi)膜樣腺癌的手術(shù)病理分期、肌層浸潤(rùn)的深度、組織分化的程度和淋巴結(jié)的轉(zhuǎn)移有關(guān)。2 Cg A在正常的子宮內(nèi)膜組織中的表達(dá)率為18.18%,而在子宮內(nèi)膜樣腺癌組織中的表達(dá)率則為50.00%。子宮內(nèi)膜樣腺癌組的COX-2的表達(dá)率較正常子宮內(nèi)膜組的表達(dá)率要高,經(jīng)統(tǒng)計(jì)學(xué)分析,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.01)。Cg A在子宮內(nèi)膜樣腺癌中的陽(yáng)性表達(dá)與子宮內(nèi)膜樣腺癌的手術(shù)病理分期、組織學(xué)分級(jí)、浸潤(rùn)的深度、淋巴的轉(zhuǎn)移無(wú)明顯相關(guān)性。3相關(guān)性分析:COX-2和Cg A兩種蛋白在子宮內(nèi)膜樣腺癌組織中的表達(dá)呈正相關(guān)(r=0.488 P=0.000)。結(jié)論:1 COX-2Ⅰ蛋白在子宮內(nèi)膜樣腺癌中高表達(dá),與子宮內(nèi)膜樣腺癌的手術(shù)病理分期、深肌層浸潤(rùn)、組織分化程度低及淋巴結(jié)的轉(zhuǎn)移有一定的相關(guān)性,與EC的發(fā)生發(fā)展有一定關(guān)系。2 Cg A在子宮內(nèi)膜樣腺癌中呈高表達(dá),與子宮內(nèi)膜樣腺癌的手術(shù)病理分期、組織學(xué)分級(jí)、浸潤(rùn)深度等無(wú)明顯相關(guān)性。3 COX-2和Cg A在子宮內(nèi)膜樣腺癌組織中表達(dá)呈正相關(guān),可能在內(nèi)膜癌發(fā)生、發(fā)展中有協(xié)同作用。
[Abstract]:Objective: endometrial carcinoma (Endometrial, Carcinoma, EC) is a kind of malignant epithelial tumors, occurring in the endometrium, is one of the three malignant tumors of female genital tract [1], and its proportion in all female malignant tumor in 7%, which accounted for in the female genital tract malignant tumor in a ratio of 20%-30% which comes from the endometrial gland carcinoma is the most common type of city, in economically developed countries and some of China's economic development, the incidence of EC in gynecological malignant tumor has been ranked in the first place, at present, its incidence in the world within the scope of [2] is rising gradually, the current EC and cancer precancerous lesion of young trend is obvious, the incidence rate of nulliparous women was increased, but so far, its pathogenesis is still not completely clear [3] in clinic at present all view, more identity is "no resistance to estrogen" According to the theory. Its pathogenesis for estrogen dependent or not can be divided into two types: estrogen dependent (type I) and non estrogen dependent (type II) two, estrogen dependent EC in the majority of all endometrial adenocarcinoma, usually were relatively young, and often obesity, hypertension, diabetes mellitus, pathological sterility or infertility and menopause delayed type II [4]. is relatively rare, characteristics of this type of endometrial cancer is more common in older women thin, so far has yet to find a clear cause. Cyclooxygenase -2 (Cyclooxygenase-2, COX-2) is a kind of induced transcription enzyme in physiology under normal conditions the body is not detected, but highly expressed in a variety of malignant tumors, a recent study found that the proliferation of COX-2 cells in some tumors, play a role in anti apoptosis and angiogenesis, and tumor occurrence, development The exhibition is closely related to the prognosis of [5]. and the traditional view that the type of EC and neuroendocrine closely related, only a small amount of endocrine cells (Endocrine Cell) in normal endometrium, and in endometrial adenocarcinoma tissues but more common endocrine cells are still not clear, so far, these endocrine cells appeared and its significance the relationship with the biological behavior of EC. Chromogranin A (Chromogranin A, Cg A) is a marker of neuroendocrine specific. In this study, by detecting the COX-2 expression of Cg A in type EC and normal endometrial tissues, explore both in the occurrence of endometrial adenocarcinoma, development at the same time to explore their role in the occurrence of endometrial adenocarcinoma, the relationship in the process of development, evaluation of prognosis of endometrioid adenocarcinoma and treatment guidance of endometrioid adenocarcinoma development new clinical pathway. Methods: this experiment selects 1 May 2014 ~2016 year in August in Hebei People's Hospital for the surgical treatment of EC patients with 52 cases, the postoperative examination of hysterectomy, pathological results were endometrioid adenocarcinoma, the endometrial adenocarcinoma specimens as the experimental group. The benign lesions were selected to give a full house factor or ovarian uterus resection of 22 patients as the control group, and the postoperative pathology results of normal endometrium.2 by immunohistochemical method (SP method) to detect paraffin sections of 52 cases of endometrial adenocarcinoma and 22 cases of normal endometrium in COX-2 Cg, the expression of A.3 COX-2.4 analysis, the relationship between Cg the expression of A protein in endometrial adenocarcinoma and the clinicopathologic features by using SPSS17.0 statistical software for statistical analysis and processing, P0.05.5 was statistically significant Spearman correlation analysis of two in endometrioid adenocarcinoma The relationship between the expression of cancer tissues. Results: the positive expression of COX-2 in 1 normal endometrial tissue in the rate of 36.36%, the positive expression in endometrial adenocarcinoma tissues the expression of 80.77%. in endometrial carcinoma group COX-2 compared with normal endometrium group was higher, the comparison between the two groups there were statistically significant differences (P0.01) pathology and the expression of.COX-2 in endometrial adenocarcinoma stage, myometrial invasion depth, the degree of expression of tissue differentiation and lymph node metastasis of.2 Cg A in normal endometrial tissue in the rate of 18.18%, while the expression in endometrioid adenocarcinoma tissues the rate for expression of 50.00%. in endometrial cancer group COX-2 compared with normal endometrium group was higher, statistically, there was significant difference between two groups (P0.01).Cg positive expression of A in endometrioid adenocarcinoma and Surgical pathology in endometrial cancer staging, histological grade, infiltration depth, analysis of correlation between.3 associated lymphoid metastasis: no expression of COX-2 was positively related to Cg and A two proteins in endometrioid adenocarcinoma tissues (r=0.488, P=0.000). Conclusion: 1 COX-2 1 protein highly expressed in endometrial adenocarcinoma, pathology and endometrial cancer staging, deep myometrial invasion, metastasis have differentiated and lymph nodes, there is a relationship between.2 Cg A showed high expression in endometrioid adenocarcinoma and the occurrence and development of EC, pathology and endometrioid adenocarcinoma cancer staging, histological grade, depth of invasion, there was no correlation between.3 COX-2 and Cg A expression in endometrial adenocarcinoma tissue was positively correlated, may occur in endometrial carcinoma, synergistic effect in the development.

【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】：2017
【分類號(hào)】：R737.33

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