新疆部分地区维、汉族葡萄胎临床特点分析及恶变因素研究

发布时间：2018-06-12 23:07

本文选题：葡萄胎 + 恶变因素　；参考：《新疆医科大学》2017年硕士论文

【摘要】：目的:(1)比较新疆局部地区维、汉民族葡萄胎患者临床资料的差异性;(2)探讨E-cadherin和Laminin对不同类型葡萄胎(葡萄胎和侵蚀性葡萄胎)的诊断价值;(3)对葡萄胎患者恶变患者的临床资料进行回顾性分析其高危致病因素。方法:(1)选择自2010年03月至2015年03月在新疆医科大学第一附属医院妇科住院的维汉族葡萄胎患者167例,对其年龄,民族构成等临床资料进行分析(2)对纳入研究167例维汉族葡萄胎患者进行随访,跟踪其预后,结果发展为妊娠滋养细胞肿瘤(GTN)17例(其中包括侵蚀性葡萄胎13例和绒癌者4例),并对其孕产次,妊娠年龄,血清β-HCG水平,子宫大小,恶变等因素进行回顾性研究;(3)采用免疫组化SP法检测我院保存较为完整的75例葡萄胎患者石蜡包埋组织中的E-cadherin和Laminin的表达。结果:(1)E-cadherin和Laminin在部分性葡萄胎、完全性葡萄胎和侵蚀性性葡萄胎中具有表达。(2)E-cadherin和Laminin在葡萄胎和侵蚀性性葡萄胎表达强度存在差异,且差异有统计学意义(P0.05)(3)在167例葡萄胎病例中,其中汉族107例,所占比例为为64.1%;维吾尔族60例,所占比例为35.9%,结合研究统计期间在我院所发生的妊娠总例数,比较维汉族葡萄胎的发病率,结果两组间比较有统计学差异(χ2=14.844,P0.001)(4)167例患者,无自然流产史的占33人,占19.8%;有过一次流产史的42人,占25.1%;有过两次及以上流产史的92人,占55.1%,经统计学处理"g2次流产史与2次流产史,存在显著差异(均P0.001),而1次流产史和无流产史之间差异无统计学意义(P=0.180)(5)167例葡萄胎患者随访18个月,其中清宫前子宫大小10周者为42例,8例恶变,恶变率19.0%;清宫前子宫大小≤10周者为125例,9例恶变,恶变率7.2%。两组间孕周比较有统计学意义(χ2=4.826,P0.05)(6)17例恶变患者中,其中汉族为15人,恶变率为14.0%,维吾尔族为2人,恶变率为3.3%,两组间比较有统计学意义(χ2=4.801,P0.05)(7)在167葡萄胎病例者中,清宫前血HCG105MIu/m L者32例,1例恶变,恶变率3.1%;105-2×105者62例,恶变2例,恶变率3.2%;2×105MIu/m L者73例,恶变14例,恶变率19.2%;清宫前血HCG值HCG105MIu/m L者与HCG值HCG105-2×105MIu/m L者差异无统计学意义(χ2=0.001,P=0.979),清宫前HCG值HCG105-2×105MIu/m L者与2×105MIu/m L者差异有统计学意义(χ2=8.166,P=0.004),清宫前血HCG值105MIu/m L者与2×105MIu/m L者差异有统计学意义(χ2=4.682,P=0.030);结论:(1)E-cadherin和Laminin与滋养细胞的恶性潜能相关;(2)免疫组化法分析E-cadherin和Laminin可以作为不同类型葡萄胎传统诊断方法的辅助手段;(3)E-cadherin和Laminin表达强弱与滋养细胞恶性程度呈负相关;(4)维吾尔族葡萄胎发病风险较汉族人为高;(5)有过两次流产史者在葡萄胎中所占比例较高;(6)葡萄胎清宫前子宫大小10周者较易发生恶变;(7)汉族葡萄胎患者发生恶变的风险要高于维吾尔族患者(8)清宫前血HCG值大于20万者发生恶变机率较高。
[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.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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