【摘要】：目的:通過檢測(cè)Plexin-B1和MMP-9在人體胰腺癌組織、正常胰腺組織中的表達(dá)情況以及相關(guān)性,并隨訪獲取術(shù)后生存時(shí)間資料,探討Plexin-B1和MMP-9在胰腺癌發(fā)生發(fā)展中的作用以及與預(yù)后的關(guān)系。方法:1.本研究選取2012年1月至2015年1月在湖南省人民醫(yī)院肝膽外科接受胰腺手術(shù)治療的39例術(shù)后病理確診為胰腺導(dǎo)管腺癌的患者作為實(shí)驗(yàn)組,獲取其胰腺癌組織蠟塊。對(duì)39例胰腺癌根據(jù)2010年美國(guó)腫瘤聯(lián)合會(huì)(AJCC)第七版TNM分期系統(tǒng)進(jìn)行分期。通過查閱病歷獲取患者基本臨床及病理資料。取10例因胰腺外傷及其他原因接受胰腺切除者的正常胰腺組織蠟塊,作為對(duì)照組。運(yùn)用免疫組織化學(xué)的方法檢測(cè)Plexin-B1和MMP-9在胰腺癌組織以及正常胰腺組織中的表達(dá),HE染色觀察胰腺癌組織中的神經(jīng)侵犯現(xiàn)象,統(tǒng)計(jì)分析表達(dá)情況與臨床病理資料間的關(guān)系以及表達(dá)的相關(guān)性。2.從接受手術(shù)治療當(dāng)天開始計(jì)算生存時(shí)間,術(shù)后通過電話、電子郵件、手機(jī)短信、門診或住院復(fù)查等方式獲取生存時(shí)間資料,以月為單位,以患者死亡或者2015年12月為終點(diǎn)。對(duì)Plexin-B1以及MMP-9的表達(dá)以及各臨床病理因素與手術(shù)后生存時(shí)間的關(guān)系進(jìn)行單因素分析,經(jīng)單因素分析所得的P0.1的可能對(duì)生存時(shí)間產(chǎn)生影響的因素納入多因素生存分析。結(jié)果:1.Plexin-B1和MMP-9在胰腺癌組織中主要表達(dá)于胰腺癌細(xì)胞的胞漿和胞膜,二者在胰腺癌組織中都呈高表達(dá)趨勢(shì)(97.4%和92.3%),明顯高于正常胰腺組織(10%和10%),差異有統(tǒng)計(jì)學(xué)意義。MMP-9的表達(dá)在有神經(jīng)侵犯、腫瘤分化程度低的胰腺癌組織中表達(dá)更高,差異有統(tǒng)計(jì)學(xué)意義。Plexin-B1與MMP-9的表達(dá)呈正相關(guān)關(guān)系(相關(guān)系數(shù)r=0.403 P=0.011)。2.34名患者獲得術(shù)后隨訪,排除術(shù)后短期因并發(fā)癥死亡的2例,對(duì)其余32例胰腺癌患者臨床病理因素對(duì)生存期的影響進(jìn)行單因素分析,結(jié)果提示MMP-9陽(yáng)性表達(dá)、神經(jīng)侵犯、分化程度低、TNM分期較晚與患者術(shù)后生存時(shí)間縮短顯著相關(guān)(P0.05)。將P0.1的可能對(duì)生存時(shí)間產(chǎn)生影響的因素納入多因素生存分析Cox風(fēng)險(xiǎn)模型,結(jié)果提示神經(jīng)侵犯、腫瘤分化程度對(duì)患者術(shù)后生存時(shí)間的影響在納入分析的各相關(guān)因素中相對(duì)獨(dú)立,相對(duì)危險(xiǎn)度分別為0.215(P=0.002)和3.207(P=0.02)。結(jié)論:1.Plexin-B1與MMP-9在胰腺癌組織中高表達(dá),高于正常胰腺組織,二者的表達(dá)呈正相關(guān)關(guān)系,說明二者共同參與了胰腺癌的發(fā)生及發(fā)展過程。2.MMP-9在發(fā)生神經(jīng)侵犯的胰腺癌組織中表達(dá)較高,提示MMP-9可能參與胰腺癌的神經(jīng)侵犯過程。3.MMP-9陽(yáng)性表達(dá)、發(fā)生神經(jīng)侵犯、腫瘤低分化、TNM分期較晚與胰腺癌患者手術(shù)后生存時(shí)間縮短顯著相關(guān),其中,發(fā)生神經(jīng)侵犯、腫瘤低分化對(duì)胰腺癌患者手術(shù)后生存時(shí)間縮短的影響相對(duì)獨(dú)立。
[Abstract]:Objective: to investigate the expression and correlation of Plexin-B1 and MMP-9 in human pancreatic carcinoma and normal pancreatic tissues, and to investigate the role of Plexin-B1 and MMP-9 in the development and prognosis of pancreatic cancer. Method 1: 1. From January 2012 to January 2015, 39 patients with pancreatic ductal adenocarcinoma were treated by pancreatic surgery in the Department of Hepatobiliary surgery, Hunan Provincial people's Hospital. Thirty-nine cases of pancreatic cancer were staging according to the seventh TNM staging system of the American Federation of Neoplasms (AJCC) in 2010. The basic clinical and pathological data of the patients were obtained by consulting the medical records. The normal pancreatic tissue wax of 10 patients with pancreatic trauma and other reasons were taken as control group. The expression of Plexin-B1 and MMP-9 in pancreatic carcinoma and normal pancreatic tissues were detected by immunohistochemical method. Statistical analysis of the relationship between expression and clinicopathological data and the expression of correlation. 2. The survival time was calculated from the day of operation, and the survival time was obtained by telephone, email, SMS, outpatient or inpatient reexamination after the operation. The survival time was measured in months, with the death of the patient or December 2015 as the end point. The expression of Plexin-B1 and MMP-9 and the relationship between the clinicopathological factors and the survival time after operation were analyzed by univariate analysis. The factors that may influence the survival time of P0.1 were included in the multivariate survival analysis. Results 1. Plexin-B1 and MMP-9 were mainly expressed in the cytoplasm and membrane of pancreatic cancer cells. The expression of MMP-9 in pancreatic carcinoma was significantly higher than that in normal pancreatic tissue (97.4% and 92.3%), and the expression of MMP-9 was significantly higher in pancreatic carcinoma with neural invasion and low tumor differentiation than in normal pancreatic tissue (10% and 10%), and the expression of MMP-9 in pancreatic carcinoma was significantly higher than that in normal pancreatic tissue (10% and 10%). There was a positive correlation between the expression of MMP-9 and Plexin-B1 (r = 0.403 P0.011) .2.34 patients were followed up after operation, and 2 cases died because of complications after operation. Univariate analysis was carried out on the clinicopathological factors of the other 32 patients with pancreatic cancer. The results showed that the positive expression of MMP-9, the invasion of nerves and the late TNM stage were significantly correlated with the shortened survival time (P0.05). The factors that may affect survival time of P0.1 were included in Cox risk model of multivariate survival analysis. The results indicated that the influence of neural invasion and tumor differentiation on postoperative survival time of patients was relatively independent among the factors involved in the analysis. The relative risk was 0.215 (P0. 002) and 3.207 (P0. 02), respectively. Conclusion: 1. The expression of Plexin-B1 and MMP-9 in pancreatic carcinoma is higher than that in normal pancreatic tissue. The positive correlation between the expression of MMP 9 and Plexin-B1 suggests that both of them are involved in the occurrence and development of pancreatic carcinoma. 2. The expression of MMP-9 is higher in pancreatic carcinoma with neural invasion. The results suggest that MMP-9 may be involved in the neuroinvasive process of pancreatic cancer. 3. The positive expression of MMP-9 may be involved in the process of pancreatic cancer. The late TNM stage of low differentiation of tumor may be associated with the shortened survival time of pancreatic cancer patients after operation, among which, nerve invasion may occur. The effect of low tumor differentiation on postoperative survival time of pancreatic cancer patients is relatively independent.
【學(xué)位授予單位】：湖南師范大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R735.9

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