本文選題：葡萄胎 + 惡變因素��； 參考：《新疆醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:(1)比較新疆局部地區(qū)維、漢民族葡萄胎患者臨床資料的差異性;(2)探討E-cadherin和Laminin對(duì)不同類型葡萄胎(葡萄胎和侵蝕性葡萄胎)的診斷價(jià)值;(3)對(duì)葡萄胎患者惡變患者的臨床資料進(jìn)行回顧性分析其高危致病因素。方法:(1)選擇自2010年03月至2015年03月在新疆醫(yī)科大學(xué)第一附屬醫(yī)院婦科住院的維漢族葡萄胎患者167例,對(duì)其年齡,民族構(gòu)成等臨床資料進(jìn)行分析(2)對(duì)納入研究167例維漢族葡萄胎患者進(jìn)行隨訪,跟蹤其預(yù)后,結(jié)果發(fā)展為妊娠滋養(yǎng)細(xì)胞腫瘤(GTN)17例(其中包括侵蝕性葡萄胎13例和絨癌者4例),并對(duì)其孕產(chǎn)次,妊娠年齡,血清β-HCG水平,子宮大小,惡變等因素進(jìn)行回顧性研究;(3)采用免疫組化SP法檢測(cè)我院保存較為完整的75例葡萄胎患者石蠟包埋組織中的E-cadherin和Laminin的表達(dá)。結(jié)果:(1)E-cadherin和Laminin在部分性葡萄胎、完全性葡萄胎和侵蝕性性葡萄胎中具有表達(dá)。(2)E-cadherin和Laminin在葡萄胎和侵蝕性性葡萄胎表達(dá)強(qiáng)度存在差異,且差異有統(tǒng)計(jì)學(xué)意義(P0.05)(3)在167例葡萄胎病例中,其中漢族107例,所占比例為為64.1%;維吾爾族60例,所占比例為35.9%,結(jié)合研究統(tǒng)計(jì)期間在我院所發(fā)生的妊娠總例數(shù),比較維漢族葡萄胎的發(fā)病率,結(jié)果兩組間比較有統(tǒng)計(jì)學(xué)差異(χ2=14.844,P0.001)(4)167例患者,無自然流產(chǎn)史的占33人,占19.8%;有過一次流產(chǎn)史的42人,占25.1%;有過兩次及以上流產(chǎn)史的92人,占55.1%,經(jīng)統(tǒng)計(jì)學(xué)處理"g2次流產(chǎn)史與2次流產(chǎn)史,存在顯著差異(均P0.001),而1次流產(chǎn)史和無流產(chǎn)史之間差異無統(tǒng)計(jì)學(xué)意義(P=0.180)(5)167例葡萄胎患者隨訪18個(gè)月,其中清宮前子宮大小10周者為42例,8例惡變,惡變率19.0%;清宮前子宮大小≤10周者為125例,9例惡變,惡變率7.2%。兩組間孕周比較有統(tǒng)計(jì)學(xué)意義(χ2=4.826,P0.05)(6)17例惡變患者中,其中漢族為15人,惡變率為14.0%,維吾爾族為2人,惡變率為3.3%,兩組間比較有統(tǒng)計(jì)學(xué)意義(χ2=4.801,P0.05)(7)在167葡萄胎病例者中,清宮前血HCG105MIu/m L者32例,1例惡變,惡變率3.1%;105-2×105者62例,惡變2例,惡變率3.2%;2×105MIu/m L者73例,惡變14例,惡變率19.2%;清宮前血HCG值HCG105MIu/m L者與HCG值HCG105-2×105MIu/m L者差異無統(tǒng)計(jì)學(xué)意義(χ2=0.001,P=0.979),清宮前HCG值HCG105-2×105MIu/m L者與2×105MIu/m L者差異有統(tǒng)計(jì)學(xué)意義(χ2=8.166,P=0.004),清宮前血HCG值105MIu/m L者與2×105MIu/m L者差異有統(tǒng)計(jì)學(xué)意義(χ2=4.682,P=0.030);結(jié)論:(1)E-cadherin和Laminin與滋養(yǎng)細(xì)胞的惡性潛能相關(guān);(2)免疫組化法分析E-cadherin和Laminin可以作為不同類型葡萄胎傳統(tǒng)診斷方法的輔助手段;(3)E-cadherin和Laminin表達(dá)強(qiáng)弱與滋養(yǎng)細(xì)胞惡性程度呈負(fù)相關(guān);(4)維吾爾族葡萄胎發(fā)病風(fēng)險(xiǎn)較漢族人為高;(5)有過兩次流產(chǎn)史者在葡萄胎中所占比例較高;(6)葡萄胎清宮前子宮大小10周者較易發(fā)生惡變;(7)漢族葡萄胎患者發(fā)生惡變的風(fēng)險(xiǎn)要高于維吾爾族患者(8)清宮前血HCG值大于20萬者發(fā)生惡變機(jī)率較高。
[Abstract]:Objective: (1) to compare the differences in the clinical data of the patients with uvus in the local areas of Xinjiang; (2) to explore the diagnostic value of E-cadherin and Laminin for different types of hydatidiform mole (hydatidiform mole and erosive mole); (3) the clinical data of the vineal patients with vineal malignancy were retrospectively analyzed. Methods: (1) choose from 2 010 years from 03 months to 03 months in 03 months of 2015, 167 patients with uvograph in the First Affiliated Hospital of Xinjiang Medical University were treated with clinical data of their age and national constitution (2). 167 cases of uvograph were followed up and the prognosis was followed. 17 cases of pregnancy trophoblastic tumor (GTN) were developed. 13 cases of invasive hydatidiform mole and 4 cases of choriocarcinoma were reviewed, and the factors such as pregnancy, pregnancy age, serum beta -HCG level, uterus size and malignant change were reviewed. (3) the expression of E-cadherin and Laminin in paraffin embedded tissues of 75 cases of hydatidiform hydatidiform patients in our hospital were detected by immunohistochemical SP. Results: (1) E-cadherin And Laminin were expressed in partial hydatidiform mole, complete hydatidiform mole and erosive mole. (2) the expression intensity of E-cadherin and Laminin in hydatidic and erosive hydatidiform mole was different, and the difference was statistically significant (P0.05) (3) in 167 cases of hydatidiform mole, of which 107 cases were Han and 60 cases in Uygur nationality. The proportion was 35.9%. Combined with the total number of pregnancy cases in our hospital during the study and statistics, the incidence of uvus was compared between the two groups (x 2=14.844, P0.001) (4) 167 patients, no natural abortion history accounted for 33, accounting for 19.8%, 42 of abortion history, 25.1%, and more than two times and more abortion. History of 92 people accounted for 55.1%. Statistically, "G2 abortion history and 2 abortion history, there were significant differences (P0.001), but there was no statistically significant difference between the 1 abortion history and no abortion history (P=0.180) (5) 167 cases of hydatidiform mole for 18 months, of which 10 weeks before the uterus of the uterus were 42, 8 cases of malignant change, the rate 19%, and the big uterus before the palace of Qing Dynasty." There were 125 cases in less than 10 weeks and 9 cases of malignant change, and the rate of malignant change in 7.2%. two groups was statistically significant (x 2=4.826, P0.05) (6) 17 cases of malignant change, among which the Han was 15, the rate of malignant change was 14%, the Uygur was 2, the rate of malignant change was 3.3%, and there was a statistical significance between the two groups (chi square, P0.05) (7) in the 167 hydatidic cases, H 32 cases of CG105MIu/m L, 1 cases of malignant change, malignant change rate 3.1%, 105-2 x 105 cases, 2 cases of malignant change, malignant change rate 3.2%; 2 x 105MIu/m L 73 cases, malignant change 14 cases, malignant transformation rate 19.2%; the difference between HCG value HCG105MIu/m L in the pre palace blood and HCG value HCG105-2 x 105MIu/m L is not statistically significant (chi 2= 0.001,). The differences in /m L were statistically significant (x 2=8.166, P=0.004), and the difference between HCG value 105MIu/m L and 2 x 105MIu/m L was statistically significant (x 2=4.682, P=0.030). (1) E-cadherin and nourishing cells were associated with malignant potential; (2) immunohistochemical analysis could be used as a traditional diagnosis of different types of hydatidiform mole The auxiliary means of breaking method; (3) the expression of E-cadherin and Laminin was negatively correlated with the malignant degree of trophoblast; (4) the Uygur hydatidic risk of Uygur was higher than that of the Han people; (5) the proportion of the two abortion history in the hydatidiform mole was higher; (6) the uterine size of the hydatidiform hydatidus before the hydatidiform mole was more prone to malignant change; (7) the fetus of the Han nationality had a fetus. The risk of malignant transformation was higher than that of Uygur patients (8). The incidence of malignant transformation was higher in patients with HCG value before curettage than 200 thousand.
【學(xué)位授予單位】：新疆醫(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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