综合疗法治疗外阴白色病变前后VEGF、CD34的表达及意义

发布时间：2018-03-26 00:32

本文选题：外阴白色病变　切入点：综合疗法　出处：《吉林大学》2014年硕士论文

【摘要】：目的：1.研究综合疗法治疗外阴白色病变的临床疗效。2.检测综合疗法治疗前后外阴白色病变组织中血管内皮生长因子（VEGF）和人原始造血细胞抗原（CD34）的表达意义及相关性研究，近一步探讨外阴白色病变的病因及发病机制,为临床治疗提供理论依据。方法：搜集2011年1月至2012年6月来我院妇科门诊就诊的外阴白色病变患者62例，于阴道镜下病变明显处取外阴病理活检确诊，其中鳞状上皮增生（SH）32例，硬化性苔藓（LS）30例，并行免疫组化检测病变组织中VEGF、CD34的表达，对CD34染色阳性的微血管进行计数[微血管密度(MVD,micro vessel density)]。62例患者病变区域用重组人表皮生长因子凝胶、重组人IFNα-2b凝胶、雌三醇软膏药物局部治疗，并根据病情轻重，于治疗的第1、3、6个月、1年按评价标准判定临床疗效及治疗后改变，治疗结束后，于外阴原病变处再次取活检行病理学检查及免疫组化研究。比较外阴白色病变组织中VEGF、CD34治疗前后的表达情况。10例正常的外阴组织作为对照。结果：1.综合治疗前后瘙痒、弹性、颜色差异均具有统计学意义（P0.05），治疗后外阴瘙痒、皮肤色泽、弹性等均有大幅度改善，总有效率达95.16%,外阴硬化性苔藓（LS组）、外阴鳞状上皮增生（SH组）治疗的总有效率进行比较，差异无统计学意义（P0.05）。2.治疗前：外阴硬化性苔藓（LS组）的VEGF的表达和微血管数目（MVD值）均低于正常外阴皮肤组，差异有统计学意义(P＜0.05)，与外阴鳞状上皮增生（SH组）相比差异有统计学意义(P＜0.05)；外阴鳞状上皮增生（SH组）VEGF的表达和微血管数目（MVD值）与正常外阴组织相比差异无统计学意义(P＞0.05)；在LS中VEGF的表达与MVD计数存在正相关。治疗后：LS组、SH中VEGF、MVD与正常外阴皮肤组相比差异无统计学意义(P＞0.05)，，LS组与SH组相比差异无统计学意义(P＞0.05)。治疗前后LS中VEGF、MVD相比差异有统计学意义（P＜0.05)；治疗前后SH组中VEGF、MVD相比差异无统计学意义(P＞0.05)。结论：1.本研究证实综合疗法（重组人表皮生长因子凝胶、重组人IFNα-2b凝胶、雌三醇软膏）对不同组织病理类型的外阴白色病变具有显著治疗效果。 2.外阴硬化性苔藓组织中VEGF的表达减少，微血管数目减少；外阴鳞状上皮增生组织中VEGF的表达和微血管数目无明显改变，微血管结构功能障碍，与外阴白色病变有相关性。 3.经综合治疗后，微血管数目及形态功能得到明显改善。提示真皮层微循环障碍引起局部营养代谢障碍与外阴白色病变有相关性。
[Abstract]:Objective 1. To study the clinical efficacy of combined therapy in the treatment of vulvar white lesions. 2. To detect the expression of vascular endothelial growth factor (VEGF) and human primitive hematopoietic antigen (CD34) in vulvar white lesions before and after treatment. To explore the etiology and pathogenesis of vulvar white lesions and provide theoretical basis for clinical treatment. Methods: from January 2011 to June 2012, 62 cases of vulvar white lesions were collected from gynecological outpatient clinic of our hospital. The pathological biopsy of vulva was performed under colposcopy, including 32 cases of squamous epithelium hyperplasia and 30 cases of sclerosing lichen sclerosus. The expression of VEGF CD34 was detected by immunohistochemistry. The microvessels with positive CD34 staining were counted. 62 patients were treated with recombinant human epidermal growth factor gel and recombinant human IFN 伪 -2b gel. Local treatment of estriol ointment, and according to the severity of the disease, according to the 1st month, 6 months, 1 year according to the evaluation criteria to determine the clinical efficacy and changes after treatment, after the end of treatment, The expression of VEGF CD34 in white lesions of vulva was compared before and after treatment. 10 cases of normal vulvar tissues were used as control. Results 1. There were statistically significant differences in pruritus, elasticity and color before and after comprehensive treatment. After treatment, the pruritus of vulva, skin color and elasticity were greatly improved. The total effective rate was 95.16. The total effective rate was compared between the LS group of vulva lichen sclerosus and the SH group of vulvar squamous epithelium hyperplasia. Before treatment, the expression of VEGF and the number of microvessels in LS group were lower than those in normal vulvar skin group. The difference was statistically significant (P < 0.05, compared with the vulvar squamous epithelium hyperplasia group) (P < 0.05), the expression of VEGF and the number of microvessels in the vulvar squamous epithelium hyperplasia group were not significantly different from those in the normal vulvar tissue (P < 0.05), and there was no significant difference in the expression of VEGF and the number of microvessel and MVD between the vulvar squamous epithelium hyperplasia group and the normal vulvar tissue group. The expression of VEGF in LS was positively correlated with the count of MVD. After treatment, there was no significant difference in VEGF and MVD between the two groups (P > 0.05), and there was no significant difference between the two groups before and after treatment (P > 0.05), and there was no significant difference between the two groups before and after treatment (P > 0.05), and before and after treatment, there was no significant difference in VEGFMVD between the two groups (P > 0.05), and there was no significant difference between the two groups before and after treatment (P > 0.05). There was no significant difference in VEGF MVD in SH group before and after treatment (P > 0.05). Conclusion [WT5HZ] this study demonstrated that the combined therapy (recombinant human epidermal growth factor gel, recombinant human IFN 伪 -2b gel, estriol ointment) had a significant therapeutic effect on the white lesions of vulva with different histopathological types. 2. The expression of VEGF in vulvar lichen sclerosus decreased and the number of microvessels decreased, while the expression of VEGF and the number of microvessels in vulvar squamous epithelium hyperplasia did not change obviously. The dysfunction of microvessel structure and function was related to the white lesion of vulva. 3. After comprehensive treatment, the number and morphological function of microvessels were improved obviously, which suggested that the local nutritional disorders caused by dermis microcirculation disorder were related to the white lesions of vulva.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.72

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