子宫内膜非典型增生及早期内膜癌孕激素治疗前后SPAG9的表达及意义

发布时间：2018-06-24 06:56

本文选题：孕激素 + 子宫内膜非典型增生　；参考：《山东大学》2014年硕士论文

【摘要】：[背景]子宫内膜癌(Endometrial Carcinoma, EnCa)是女性生殖器三大恶性肿瘤之一,占女性生殖道恶性肿瘤总数的20%-30%,占女性恶性肿瘤的7%。从单纯内膜增生,到内膜不典型增生,再到高分化内膜癌是一个连续的病理变化过程。约有30%的侵袭性内膜癌患者由内膜复杂性不典型增生(complex atypical endometrial hyperplasia, CAEH)发展而来。对于CAEH和EnCa,筋膜外全子宫切除和双侧附件切除仍为主要的治疗方法,但手术切除子宫使女性丧失生育功能,因此内膜非典型增生(atypical endometrial hyperplasia, AEH)及早期EnCa的保守治疗受到极大的关注,尤其适用于有生育要求的年轻患者。目前常用孕激素治疗AEH及早期内膜癌,其有效性得到了证实,但并不是所有患者都得到了完全缓解。如何对患者做出准确的诊疗决策,寻找到可靠的判断孕激素保守治疗效果的生物学标志物具有重要的病理学意义及临床意义。 [目的]分析比较孕激素治疗子宫内膜复杂性非典型增生(complex atypical endometrial hyperplasia, CAEH)及早期内膜癌(Endometrial Carcinoma, EnCa)的疗效差异；研究SPAG9是否可作为判断CAEH及早期EnCa孕激素治疗适宜人群的生物标志物；探讨SPAG9是否可用于临床,辅助判断孕激素治疗子宫内膜病变的有效性,从而辅助做出诊疗决策。 [方法](1)从山东大学附属省立医院收集2010年到3013年间子宫内膜病变经过孕激素治疗的病例(共27例)。此27例病例,均经过大剂量孕激素(250mg-500mg/d)治疗,治疗前后分别行诊断性刮宫。根据治疗前诊断性刮宫结果分为为非典型增生组(19/27),早期内膜癌组(8/27)；根据治疗前后诊断性刮宫病理结果变化分为治疗有效组(21/27)及无效组(6/27)；(2)应用免疫组织化学的方法检测孕激素治疗前后子宫内膜标本中SPAG9的表达情况,对子宫内膜非典型增生组与内膜癌组孕激素治疗效果及两组之间SPAG9的表达情况进行比较；(3)对孕激素治疗有效组及无效组分别比较治疗前后子宫内膜SPAG9的表达差异。 [结果](1)子宫内膜非典型增生组较内膜癌组孕激素治疗前SPAG9表达低,且非典型增生组孕激素治疗有效率较内膜癌组高；(2)孕激素治疗有效组SPAG9表达显著下调(有统计学意义),治疗无效组SPAG9表达有上调趋势(无统计学意义)。 [结论]SPAG9表达下调可能与孕激素治疗子宫内膜非典型增生(complex atypical endometrial hyperplasia, CAEH)及早期癌的有效性相关。SPAG9的表达可以辅助鉴别AEH与EnCa,并可作为妇产科医生判断孕激素治疗适宜患者的生物学标志物。
[Abstract]:Background Endometrial carcinoma (Enca) is one of the three major malignant tumors in female genitalia, accounting for 20-30% of the total number of malignant tumors of female genital tract and 7 cases of female malignant tumors. It is a continuous pathological process from simple intimal hyperplasia to endometrial atypical hyperplasia to highly differentiated endometrial carcinoma. About 30% of invasive endometrial carcinoma patients develop from (complex atypical endometrial hyperplasia, CAEH. For CAEH and Enca, total hysterectomy and bilateral appendage resection are still the main methods of treatment, but surgical hysterectomy makes women lose reproductive function. Therefore, the conservative treatment of endometrial atypical hyperplasia (atypical endometrial hyperplasia, AEH) and early EnCa is of great concern. It is especially suitable for young patients with fertility requirements. The efficacy of progesterone in the treatment of AEH and early endometrial carcinoma has been confirmed, but not all patients have achieved complete remission. How to make accurate diagnosis and treatment decision and find the reliable biomarker to judge the effect of conservative treatment of progesterone has important pathological and clinical significance. [objective] to compare the efficacy of progesterone in the treatment of complex atypical hyperplasia of endometrium (complex atypical endometrial hyperplasia, CAEH) and early endometrial carcinoma (Enca), and to study whether SPAG9 can be used as a biomarker to judge the suitable population for CAEH and early treatment of endometrial carcinoma. To investigate whether SPAG9 can be used in clinic and to evaluate the efficacy of progesterone in the treatment of endometrial lesions. [methods] (1) 27 cases of endometrial lesions treated with progesterone from 2010 to 3013 were collected from Provincial Hospital of Shandong University. All 27 cases were treated with high dose progesterone (250mg-500mg/d) and were treated with diagnostic curettage before and after treatment. According to the results of diagnosis curettage before treatment, they were divided into atypical hyperplasia group (19 / 27), early endometrial carcinoma group (8 / 27), effective treatment group (21 / 27) and ineffective group (6 / 27) according to the pathological changes of diagnostic curettage before and after treatment. (2) Immunohistochemical method was used to detect the expression of SPAG9 in endometrial specimens before and after progesterone treatment, and to compare the effect of progesterone therapy between atypical hyperplasia of endometrium and endometrial carcinoma and the expression of SPAG9 between the two groups. (3) the expression of SPAG9 in endometrium before and after treatment were compared between the effective group and the ineffective group. [results] (1) the expression of SPAG9 in atypical hyperplasia group was lower than that in endometrial carcinoma group, and the effective rate of progesterone therapy in atypical hyperplasia group was higher than that in endometrial carcinoma group. (2) the expression of SPAG9 in the effective group of progesterone treatment was significantly down-regulated (P < 0.05), but the expression of SPAG9 was up-regulated in the ineffective group (no significant difference). [conclusion] the down-regulation of SPAG9 expression may be related to the efficacy of progesterone in the treatment of endometrial atypical hyperplasia (complex atypical endometrial hyperplasia, CAEH) and early stage carcinoma. The expression of SPAG9 may assist in differentiating AEH from EnCa, and can be used as a gynaecologist to determine the appropriate treatment of progesterone. Appropriate biomarkers for patients.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

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