人端粒酶RNA在预测低度宫颈上皮内瘤变患者疾病转归中的价值

发布时间：2018-03-20 19:29

  本文选题：宫颈上皮内瘤变　切入点：人端粒酶基因(hTERC基因)　出处：《南京大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：通过检测经组织病理学诊断为低度宫颈上皮内瘤变(CIN1级)患者的宫颈脱落细胞中的人端粒酶RNA(hTERC基因),并随访高危HPV感染的CIN1级患者2年的疾病专归及HPV转阴情况。分析人端粒酶RNA与CIN1患者的疾病转归以及高危HPV转阴率之间的关系,明确hTERC基因在预测宫颈上皮内瘤变1级患者的疾病转归中的价值,从而为CIN1级患者的临床诊治提供参考依据。方法：选择2010年1月到2011年4月在南京大学附属鼓楼医院妇科就诊,经阴道镜下活检病理诊断为CIN1并且均为高危HPV感染的患者118名。用专用保存液及宫颈刷收集每位患者的宫颈脱落细胞,用荧光原位杂交法检测hTERC基因。定期随访2年。将实施宫颈环形电切术的56名病人作为手术组,将未行手术治疗的62名病人作为非手术组；根据hTERC检测结果分为hTERC基因阳性组和hTERC基因阴性组(该检测结果在随访结束后揭盲)。所有患者均以宫颈液基细胞学检查(TCT)联合高危型HPV(HR-HPV)DNA检测(HC-II)作为随访的监测方法,每6-12个月随访一次,必要时行阴道镜下多点活检并行病理检查,以HPV、TCT及组织病理学诊断相结合来判定患者的疾病转归。用SPSS17.0软件分析数据,运用x 2检验或FISHER精确检验法分析hTERC基因与CIN1患者疾病转归及高危HPV转阴率之间的关系,并分析宫颈环形电切手术在治疗CIN1患者中的价值,评价FISH法检测hTERC基因在预测低度宫颈上皮内瘤变患者疾病转归并且在临床诊治中分流此类患者的应用价值。结果：1、随访24个月时共失访1人,因于外院行物理治疗而剔除2人,完成随访115人,累积随访率为97.46%。2、非手术组患者在随访12个月及24个月时,hTERC基因阳性组患者的病变进展及持续比例明显高于hTERC基因阴性组(P0.05),而hTERC基因阳性组患者的病变逆转比例明显低于hTERC基因阴性组(P0.05),差异有统计学意义。3、手术组中hTERC基因阳性组和hTERC基因阴性组的患者在随访12个月和24个月时疾病的转归经统计学计算无显著性差异(P0.05)。4、宫颈环形电切术可以明显改善hTERC基因阳性的CIN1患者的预后(P0.05),但对hTERC基因阴性的CIN1患者的长期预后无明显的影响(P0.05)。5、非手术组CIN1患者中hTERC基因阳性组的高危HPV转阴情况明显低于hTERC基因阴性组(P0.05),差异有统计学意义；手术组患者中hTERC基因阳性组与hTERC基因阴性组的高危HPV转阴情况无显著性差异(P0.05)。结论：1、2年内hTERC基因阴性的CIN1患者有较高的疾病逆转比例,以及明显高hTERC基因阳性CIN1患者的高危HPV转阴率。2、宫颈环形电切术可以改善hTERC基因阳性的CIN1患者的预后,但是对hTERC基因阴性的CIN1患者的长期预后无显著的作用。3、hTERC基因或许可以作为预测CIN1患者的疾病转归,成为分流CIN1患者的一项生物学指标,对临床处理低度宫颈上皮内瘤变患者有较大的参考价值。
[Abstract]:Objective: to detect the human telomerase RNA(hTERC gene in cervical exfoliated cells of patients diagnosed by histopathology as low grade cervical intraepithelial neoplasia (cin 1), and to follow up the disease and HPV conversion of CIN1 grade patients with high risk of HPV infection for 2 years. To analyze the relationship between human telomerase RNA and the outcome of CIN1 and the negative rate of high risk HPV. To determine the value of hTERC gene in predicting the outcome of cervical intraepithelial neoplasia grade 1 patients. Methods: from January 2010 to April 2011, Gynaecology of Gulou Hospital, Nanjing University, was selected. The cervical exfoliative cells were collected from 118 patients with CIN1 diagnosed by colposcopy biopsy and all of them with high risk of HPV infection. The hTERC gene was detected by fluorescence in situ hybridization (Fish) and followed up for 2 years. 56 patients undergoing circular electroresection of cervix were selected as the operation group and 62 patients who were not treated by operation as the non-operative group. According to the results of hTERC, they were divided into hTERC gene positive group and hTERC gene negative group. All the patients were followed up by cervical liquid-based cytology combined with high risk HPV(HR-HPV)DNA. The patients were followed up every 6-12 months. If necessary, multipoint biopsy under colposcopy and pathological examination were performed to determine the outcome of the disease by combining HPV-TCT with histopathological diagnosis. The data were analyzed by SPSS17.0 software. The relationship between hTERC gene and disease outcome and high risk HPV negative rate in patients with CIN1 was analyzed by means of x2 test or FISHER accurate test. The value of cervical circular electrotomy in the treatment of CIN1 patients was also analyzed. To evaluate the value of hTERC gene detection by FISH in predicting the outcome of low-grade cervical intraepithelial neoplasia and shunt such patients in clinical diagnosis and treatment. 115 patients were followed up. The cumulative follow-up rate was 97.46.1%. The pathological progression and persistent rate of patients with positive hTERC gene were significantly higher in the non-operative group than in the negative group of hTERC gene at 12 and 24 months, while the proportion of the patients with positive hTERC gene was significantly higher than that of the patients with positive hTERC gene. The difference was statistically significant. There was no significant difference in the prognosis of the patients with hTERC gene positive and hTERC gene negative group after 12 and 24 months follow-up. There was no significant difference in the prognosis of cervix and cervix. Loop electroresection can significantly improve the prognosis of CIN1 patients with hTERC gene positive, but it has no significant effect on the long-term prognosis of CIN1 patients with hTERC gene negative. The high risk HPV negative situation of hTERC gene positive group in non-operative group CIN1 patients is clear. The significant difference was significantly lower than that in hTERC gene negative group (P 0.05). There was no significant difference between the hTERC gene positive group and the hTERC gene negative group in the high risk HPV negative conversion in the operation group (P 0.05). Conclusion there is a higher rate of disease reversal in the CIN1 patients with hTERC gene negative within 1 to 2 years after operation. The high risk HPV negative rate of CIN1 patients with high hTERC gene was significantly higher than that of the patients with high hTERC gene positive. Cervical circular electrotomy could improve the prognosis of CIN1 patients with hTERC gene positive. But it has no significant effect on the long-term prognosis of CIN1 patients with negative hTERC gene. 3hTERC gene may be used as a biological index for predicting the outcome of CIN1 patients and shunt CIN1 patients. It has great reference value for clinical treatment of low grade cervical intraepithelial neoplasia.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

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