【摘要】：目的：1、證實(shí)程序性死亡因子(PD-1)的配體PD-L1在在位內(nèi)膜、異位內(nèi)膜中表達(dá)；對(duì)比觀察PD-L1在子宮肌瘤患者內(nèi)膜組織、子宮內(nèi)膜異位癥(endometriosis,EMs)患者在位及異位內(nèi)膜中的表達(dá)情況,分析是否存在差異；探討PD-L1在EMs發(fā)病中的作用和臨床意義。2、研究?jī)?nèi)異停方對(duì)卵巢巧克力囊腫(ovarian endometriosis,OEM)患者病灶PD-L1表達(dá)的影響,探討內(nèi)異停治療EMs的機(jī)制,尋求內(nèi)異癥治療的新突破。方法：1、選取病例對(duì)照的研究方法,對(duì)PD-L1在各組織中的表達(dá)進(jìn)行研究。標(biāo)本均源于江蘇省中醫(yī)院2014年3月～2015年6住院手術(shù)治療的患者。腺肌癥患者18例,取其異位及在位內(nèi)膜；20例巧囊患者的異位內(nèi)膜；18例子宮肌瘤患者在位內(nèi)膜、病灶及正常肌壁組織。應(yīng)用免疫組化方法檢測(cè)PD-L1在各組織中的表達(dá)情況。2、將2014年3月～2015年12月江蘇省中醫(yī)院門診內(nèi)異停治療2月,經(jīng)手術(shù)確診為巧囊的患者20人作為試驗(yàn)組,未治療直接手術(shù)的患者20人作為對(duì)照組。對(duì)比觀察兩組異位內(nèi)膜中PD-L1的表達(dá)情況,并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果：1、(1)PD-L1廣泛表達(dá)于內(nèi)膜組織中,但相較于肌瘤組,腺肌癥患者的陽性表達(dá)率及強(qiáng)度更高；(2)各組病灶組織中也均有表達(dá)且存在差異,其中巧囊病灶表達(dá)陽性率最高,腺肌癥次之,肌瘤最低；(3)腺肌癥患者病灶與內(nèi)膜中PD-L1的表達(dá)存在一定的線性關(guān)系,子宮肌瘤患者病灶與內(nèi)膜PD-L1的表達(dá)不存在線性關(guān)系。(4)正常肌壁組織PD-L1少量表達(dá)。2、中藥組PD-L1表達(dá)總陽性率80%,強(qiáng)陽占20%(4/20),中陽15%(3/20),弱陽45%(9/20),陰性20%(4/20)；對(duì)照組總陽性率達(dá)100%,強(qiáng)陽占60%(12/20),中陽35%(7/20),弱陽5%(1/20),陰性0%(0/20)。兩組差異性比較P為0,差異有非常顯著的統(tǒng)計(jì)學(xué)意義,中藥組陽性率明顯下降。結(jié)論：1、PD-L1在內(nèi)異癥患者在位、異位內(nèi)膜中均有較高的表達(dá),異位內(nèi)膜與在位內(nèi)膜中PD-L1的表達(dá)陽性率存在一定的線性關(guān)系。對(duì)比子宮肌瘤組的低表達(dá),我們認(rèn)為內(nèi)異癥的發(fā)病與PD-L1存在相關(guān)性。2、內(nèi)異停方可以降低EMs患者異位病灶PD-L1的表達(dá),PD-L1在EMs的發(fā)生發(fā)展中發(fā)揮了重要的作用。
[Abstract]:Objective to confirm the expression of PD-L1 in eutopic endometrium and ectopic endometrium, and to observe the expression of PD-L1 in eutopic and ectopic endometrium in patients with endometriosis and endometriosis. To study the effect of PD-L1 on the expression of PD-L1 in the lesions of patients with ovarian's chocolate cyst (ovarian), to explore the mechanism of treatment of EMs, and to seek a new breakthrough in the treatment of endometriosis by analyzing the effect of PD-L1 on the pathogenesis of EMs and the clinical significance of PD-L1, and to explore the effect of Neiyidingfang on the expression of PD-L1 in the lesions of patients with ovarian chocolate cyst (ovarian). Methods: 1. The expression of PD-L1 in all tissues was studied by case-control method. The specimens were collected from 6 hospitalized patients in Jiangsu Provincial Hospital of traditional Chinese Medicine from March 2014 to 2015. 18 cases of adenomyosis, 20 cases of ectopic endometrium and 20 cases of ectopic endometrium, 18 cases of hysteromyoma and 18 cases of normal muscle wall. The expression of PD-L1 in various tissues was detected by immunohistochemical method. Twenty patients diagnosed as skillful sac by operation for 2 months from March 2014 to December 2015 in Jiangsu Provincial Hospital of traditional Chinese Medicine were selected as experimental group. Twenty patients without direct operation were used as control group. The expression of PD-L1 in ectopic endometrium was observed and statistically analyzed. Results: (1) PD-L1 was widely expressed in endometrial tissue, but the positive rate and intensity of PD-L1 were higher in adenomyosis than in leiomyoma. Adenomyosis followed by leiomyoma. (3) there was a linear relationship between PD-L1 expression in adenomyosis and the expression of PD-L1 in endometrium. There was no linear relationship between the expression of PD-L1 and the expression of PD-L1 in uterine leiomyoma. (4) there was no linear relationship between the expression of PD-L1 and PD-L1. (4) the positive rate of PD-L1 was 80 in the traditional Chinese medicine group, 20% (4 / 20) in the strong positive group, 15% (3 / 20) in the Zhongyang group, 45% (9 / 20) in the weak positive group and 20% (4 / 20) in the negative group. The total positive rate of the control group was 100. The positive rate was 60% (12 / 20), the positive was 35% (7 / 20), the weak positive was 5% (1 / 20), and the negative was 0 / 20 (0 / 20). The difference between the two groups (P = 0) was statistically significant, and the positive rate of TCM group decreased significantly. Conclusion there is a high expression of PD-L1 in ectopic endometrium and there is a linear relationship between the expression of PD-L1 in ectopic endometrium and the positive rate of PD-L1 in eutopic endometrium. Compared with the low expression of PD-L1 in patients with hysteromyoma, we believe that the pathogenesis of endometriosis has a correlation with PD-L1, and the expression of PD-L1 in ectopic lesions of EMs can be reduced by Neiyidanfang. PD-L1 plays an important role in the occurrence and development of EMs.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R271.9

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