本文選題：乳腺癌 + 癌胚抗原��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的檢測血清及乳頭溢液中癌胚抗原(Carcinoembryonic antigen,CEA)、糖類抗原153(carbohydrate antigen 153,CA153)、組織中環(huán)氧化物酶2(cyclooxygenase-2,COX-2)的水平,探討其在乳腺癌中表達(dá)的意義。方法①血清和乳頭溢液標(biāo)本中CA153和CEA檢測:收集256例乳腺浸潤性導(dǎo)管癌病例作為乳腺癌組(包括86例有乳頭溢液患者),60例普通型乳腺導(dǎo)管增生病變伴有乳頭溢液者作為良性對照組。用電化學(xué)發(fā)光法羅氏全自動(dòng)電化學(xué)發(fā)光分析儀E-601檢測血清及乳頭溢液中CEA、CA153的含量,分析血清和乳頭溢液CA153和CEA在乳腺癌組與良性對照組之間的差異,比較淋巴結(jié)轉(zhuǎn)移、遠(yuǎn)處臟器轉(zhuǎn)移和復(fù)發(fā)陽性組與陰性組的差異。②乳腺組織中COX-2檢測:選取256例乳腺浸潤性導(dǎo)管癌中的128例(包括有乳頭溢液的86例)作為乳腺癌組,其中86例有隨訪資料;癌前病變組(包括89例導(dǎo)管原位癌和57例非典型導(dǎo)管增生)、良性對照組(60例普通型乳腺導(dǎo)管增生病變伴有乳頭溢液),用免疫組織化學(xué)UltraSensitiveTM S-P法檢測不同組別乳腺組織中COX-2的水平,分析COX-2在乳腺癌組與其他組別中表達(dá)的差異,比較COX-2與乳腺癌腫瘤大小、發(fā)病年齡、組織學(xué)分級、腫瘤分期、淋巴結(jié)有無轉(zhuǎn)移的關(guān)系;③分析血清及乳頭溢液中CEA、CA153和組織中COX-2水平的相關(guān)性。結(jié)果①乳腺癌患者乳頭溢液和血清CEA、CA153水平明顯高于良性對照組(P0.01),且乳頭溢液CA153、CEA檢出量明顯高于血清(P0.01)。②乳頭溢液和血清聯(lián)合檢測敏感性達(dá)到97.7%,陰性預(yù)測值99.0%。乳頭溢液與血清聯(lián)合檢測敏感性較單項(xiàng)指標(biāo)檢測及其他組合比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。單因素分析顯示,乳頭溢液CA153、CEA可以作為乳腺癌常規(guī)檢測指標(biāo);多因素分析顯示,CA153、CEA血清和乳頭溢液的聯(lián)合檢測診斷乳腺癌的敏感性、準(zhǔn)確性、陰性預(yù)測值與各單項(xiàng)檢查比較明顯提高(P0.05)。③乳腺癌高分級(Ⅲ)組乳頭溢液CEA、CA153水平明顯高于低分級(Ⅰ+Ⅱ)組;有淋巴結(jié)轉(zhuǎn)移與無轉(zhuǎn)移組、復(fù)發(fā)與無復(fù)發(fā)乳頭溢液CEA、CA153水平比較差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。④免疫組織化學(xué)分析顯示COX-2是在普通型乳腺導(dǎo)管增生病變組中僅15.4%(10/60)表達(dá),且表達(dá)強(qiáng)度較弱;浸潤性導(dǎo)管癌組COX-2(78.9%、101/128)的陽性率高于導(dǎo)管原位癌組(55.1%,49/89)、非典型導(dǎo)管增生組(42.1%,24/57)和普通型乳腺導(dǎo)管增生組,差異均有統(tǒng)計(jì)學(xué)意義(均P0.05);但導(dǎo)管原位癌與非典型導(dǎo)管增生COX-2表達(dá)比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。⑤在乳腺癌組中COX-2表達(dá)與乳腺癌組織學(xué)分級、淋巴結(jié)轉(zhuǎn)移、遠(yuǎn)處轉(zhuǎn)移有關(guān)(P0.01),但與年齡相關(guān)的表達(dá)、腫瘤大小無關(guān)(P0.05)。⑥乳腺癌COX-2陽性組CEA和CA153水平明顯超過陰性組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論①CA153、CEA血清和乳頭溢液聯(lián)合檢測,比單項(xiàng)檢測及其他組合更有意義,可作為乳腺癌的一個(gè)單獨(dú)變量;②乳腺癌患者血清和乳頭溢液CA153和CEA與組織中COX-2呈正相關(guān);③檢測組織COX-2表達(dá)和血清CA153、CEA水平可指導(dǎo)預(yù)后評估和隨訪。
[Abstract]:Objective to detect the level of Carcinoembryonic antigen (CEA), carbohydrate antigen 153 (carbohydrate antigen 153, CA153) and the level of epoxidase 2 (cyclooxygenase-2, COX-2) in the tissues of the serum and nipple discharge, and to explore the significance of its expression in breast cancer. The detection of CA153 and CEA in serum and nipple spillage specimens: 256 cases of milk and milk Adenocarcinoma cases were used as breast cancer group (including 86 cases with nipple discharge), 60 cases of common mammary duct hyperplasia with nipple discharge as benign control group. The content of CEA, CA153 in serum and nipple spillage was detected by electrochemiluminescence Roche automatic electrochemiluminescence analyzer E-601, and serum and nipple spillage was analyzed. The difference of CA153 and CEA between the breast cancer group and the benign control group, compared with the lymph node metastasis, the distant visceral metastasis and the recurrence positive group and the negative group. (2) the COX-2 detection in mammary gland tissue: 128 cases of breast invasive ductal carcinoma (including 86 cases with nipple discharge) were selected as breast cancer group, and 86 cases were followed up. Precancerous lesion group (including 89 cases of ductal carcinoma in situ and 57 cases of atypical ductal hyperplasia), benign control group (60 cases of common mammary duct hyperplasia with nipple discharge), the level of COX-2 in breast tissue of different groups was detected by immunohistochemistry UltraSensitiveTM S-P method, and the difference of COX-2 expression in breast cancer group and other group was analyzed. The correlation between COX-2 and breast cancer size, age, histological grade, tumor staging, lymph node metastasis, and the correlation of CEA, CA153 and COX-2 levels in the serum and nipple spills were analyzed. Results (1) the level of nipple discharge and serum CEA and CA153 in breast cancer patients was significantly higher than that of the benign control group (P0.01), and the nipple discharge CA 153, the detection of CEA was significantly higher than that of serum (P0.01). The sensitivity of the combined detection of nipple discharge and serum was 97.7%, and the negative predictive value of 99.0%. nipple discharge and serum combined detection sensitivity was compared with the single index detection and other combination, the difference was statistically significant (P0.05). The single factor analysis showed that the nipple discharge CA153, CEA could be used as the mammary gland. The multifactor analysis showed that the sensitivity, accuracy and negative predictive value of CA153, CEA serum and nipple discharge in the diagnosis of breast cancer were significantly improved (P0.05). (3) high grade (III) group of breast cancer (III) group nipple discharge CEA, CA153 level was significantly higher than that of low grade (I + II) group; lymph node metastasis and lymph node metastasis There was significant difference in CEA and CA153 levels between relapse and non recurrent nipple discharge (P0.01). (P0.01). (4) immunohistochemical analysis showed that COX-2 was only 15.4% (10/60) expression in the common ductal hyperplasia group and weak expression, and the positive rate of COX-2 (78.9%, 101/128) in invasive ductal carcinoma group was higher than that of catheter in situ. Cancer group (55.1%, 49/89), atypical ductal hyperplasia group (42.1%, 24/57) and common type of mammary duct hyperplasia were statistically significant (P0.05), but there was no significant difference in COX-2 expression between ductal carcinoma in situ and atypical ductal hyperplasia (P0.05). (5) the expression of COX-2 in the breast cancer group and the histological grade of breast cancer, lymph node metastasis, and far away from the breast cancer group. Metastasis related (P0.01), but with age related expression, tumor size was not related (P0.05). (6) the level of CEA and CA153 in COX-2 positive group of breast cancer was significantly higher than that of negative group, and the difference was statistically significant (P0.05). Conclusion (1) CA153, CEA serum and nipple discharge are more significant than single test and other combination, and can be used as a single breast cancer single. The serum and nipple discharge CA153 and CEA of the breast cancer patients were positively related to the COX-2 in the tissues; (3) the expression of COX-2 and the serum CA153 and CEA levels could guide the evaluation and follow-up of the prognosis.

【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.9

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