新疆部分区域妊娠滋养细胞疾病发生及恶化的高危因素研究

发布时间：2018-03-19 15:44

  本文选题：妊娠滋养细胞疾病　切入点：恶性程度　出处：《新疆医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：(1)比较新疆部分区域维、汉民族妊娠滋养细胞疾病发病差异性；(2)分析E-粘钙素(E-cadherin)在正常早孕绒毛组织、葡萄胎组织、侵蚀性葡萄胎组织及绒毛膜癌组织中表达强度,探讨其与滋养细胞恶性潜能的关系；(3)对恶性转化的葡萄胎患者进行回顾性分析总结其高危因素。方法：(1)选择自2008年3月至2013年3月在新疆医科大学第一附属医院妇科住院的妊娠滋养细胞疾病患者108例,应用免疫组化SP法检测65例葡萄胎绒毛,36例侵蚀性葡萄胎绒毛,7例绒癌组织及30例(孕周小于12周)正常绒毛中E-粘钙素表达强度；(2)对108例维-汉妊娠滋养细胞疾病患者的发病率进行统计分析；65例葡萄胎患者随访2年,发展为侵蚀性葡萄胎和绒癌者13例,对其妊娠年龄,停经时间,血β-HCG水平等因素进行回顾性研究；所有数据采用SPSS17.0软件,等级资料采用秩和检验,计数资料采用卡方检验,检验水准取a=0.05,P0.05表示差异有统计学意义。结果：(1)E-粘钙素在正常早孕绒毛、葡萄胎、侵蚀性葡萄胎以及绒毛膜癌组织中均有表达(2)4组病例E一钙粘素表达强度呈递减趋势,经两两比较正常早孕绒毛和葡萄胎中表达强度差异有显著性(P=0.042)；侵蚀性葡萄胎及绒癌表达强度差异无显著性(P=0.514)。(3)108例病例中,汉族63例,发病率为58.3%；维吾尔族45例,发病率为41.7%,两组间比较有统计学差异(x2=4.19,P0-05)(4)108例患者,年龄小于23岁者35人,占32.4%;23-35岁者27例,占25.0%；高于35岁者46例,占42.6%,经统计学处理高于35岁以上者(x2=4.84,P0.05)发病率较高；(5)65例葡萄胎患者随访2年,其中停经时间≥12周者为35例,11例恶变,恶变率31.4%；停经时间12周者为30例,2例恶变,恶变率6.7%。两组间孕周比较有统计学意义(x2=6.19,P0.05)(7)65例葡萄胎患者中血HCG4周转阴者5例,1例恶变,恶变率20%；4～8周转阴者20例,恶变1例,恶变率5%；8周后转阴者40例,恶变11例,恶变率27.5%；血β-HCG水平转阴时间4周与4-8周两组无统计学意义(x2=1.20,P0.05)；转阴时间4周与8周的两组差异无统计学意义(x2=0.13,P,0.05)。转阴时间4-8周与8周的两组差异有统计学意义(x2=4.21,P0.05)。结论：(1)E-粘钙素在正常绒毛和滋养细胞绒毛中均有表达,并恶性程度不同,其表达部位也不同；(2)E-粘钙素与滋养细胞的恶性潜能有关：(3)E-粘钙素表达强弱与滋养细胞恶性程度呈负相关；(4)汉族病人患病风险较维吾尔族为高；(5)年龄大于35岁者发病率较高；(6)停经时间≥12周者较易恶变为侵蚀性葡萄胎；(7)血β-HCG8周转阴者恶变率较高。
[Abstract]:Objective to analyze the expression of E-cadherin in normal early pregnancy villus tissues, hydatidiform mole tissues, invasive hydatidiform mole tissues and choriocarcinoma tissues. To explore the relationship between trophoblastic malignancy and malignant potential of trophoblastic cells. (3) retrospective analysis of the high risk factors of malignant transformation of hydatidiform mole. Methods: 1) selected from March 2008 to March 2013 in the first affiliated Hospital of Xinjiang Medical University. 108 cases of gestational trophoblastic disease hospitalized in gynecology, Immunohistochemical SP method was used to detect the expression intensity of E-mucocalcin in 65 cases of hydatidiform villi and 36 cases of invasive hydatidiform mole villi in 7 cases of choriocarcinoma and 30 cases of normal villi (gestational week < 12 weeks). The incidence of hydatidiform mole was analyzed statistically in 65 patients with hydatidiform mole. Thirteen cases of invasive hydatidiform mole and choriocarcinoma were studied retrospectively, such as gestational age, menopause time and serum 尾 -HCG level, all data were analyzed by SPSS17.0 software, rank sum test was used for grade data, and chi-square test was used for counting data. Results the expression of E-cadherin in normal early pregnancy villi, hydatidiform mole, invasive hydatidiform mole and choriocarcinoma tissues showed a decreasing trend. There was significant difference in expression intensity between normal villus and hydatidiform mole by pairwise comparison, but there was no significant difference in expression intensity between invasive hydatidiform mole and choriocarcinoma, 63 cases were Han nationality, the incidence rate was 58.3%, and 45 cases were Uygur nationality. The incidence rate was 41.7%. There was a statistical difference between the two groups in 4108 patients, 35 of whom were younger than 23 years old (32.4%), 27 cases (25.0%) were aged 32.4 years, 46 cases were over 35 years old. The incidence of hydatidiform mole in 65 patients with hydatidiform mole was higher than that of 35 years old (P 0.05). Among them, 35 cases had malignant change in 35 cases whose menopause time was more than 12 weeks, and 30 cases had malignant change in 30 cases after 12 weeks of menopause. There were significant differences between the two groups in gestational weeks. Among the 65 cases of hydatidiform mole, there were 5 cases of HCG4 turning negative in 5 cases, 20 cases of malignant transformation in 20 ~ 48 weeks, 1 case of malignant change, 40 cases of negative conversion after 58 weeks of malignant change, 11 cases of malignant change. There was no significant difference between the two groups in the conversion time of serum 尾 -HCG between 4 weeks and 4 to 8 weeks (P 0.05), but there was no significant difference between the two groups in the conversion time of 4 weeks and 8 weeks. There was no significant difference between the two groups in the conversion time from 4 weeks to 8 weeks (P 0.05). Conclusion there is significant difference between the two groups in the time of turning negative between 4 and 8 weeks and between the two groups at week 4 to week 8. Conclusion there is no significant difference between the two groups in the time of turning to negative at 4 weeks and 8 weeks. Conclusion there is no significant difference between the two groups. E- mucocalcin was expressed in both normal and trophoblastic villi. And with varying degrees of malignancy, The expression of E-mucocalcin was correlated with the malignant potential of trophoblastic cells. There was a negative correlation between the expression of E-mucocalcin and the malignancy of trophoblastic cells. (4) the risk of disease in Han patients was higher than that in Uygur patients (> 35 years old). Patients with menopause time 鈮，

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