女性自发性气胸临床特点

发布时间：2018-03-18 20:35

本文选题：气胸　切入点：女性　出处：《东南大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：自发性气胸(spontaneous pneumothorax, SP)性别差异明显,通过临床工作,病历资料分析及实验室检查,分析女性SP患者肺大疱标本雌激素受体(estrogen receptor, ER)、孕激素受体(progesterone receptor, PR)、CD 10的表达和FLCN (folliculin)的基因突变,归纳女性SP患者的临床特点,为女性SP临床个体化诊治提供借鉴和指导。方法：回顾性分析东南大学附属南京市胸科医院2011年01月至2015年06月834例(其中男738例,女96例)临床诊断SP患者的临床资料；包括患者发病年龄,既往史,重点了解是否存在气胸家族发病、皮肤损害、肾脏肿瘤、慢性阻塞性肺病(chronic obstructive pulmonary disease, COPD)、肺结核(pulmonary tuberculosis)等,肺大疱(pulmonary bullae)发生的侧别、位置、大小、形态,术中探查所见肺大疱分布位置,术后置管及住院时间。选取34例女性SP患者手术切除标本行免疫组化染色评分,评估肺组织中雌激素受体、孕激素受体及CD10的表达强度。对217例(其中男192例,女25例)有家族史或高度怀疑BHD综合征的患者行外周血FLCN基因突变检测。结果：①女性患者发病年龄存在两个高峰,分别在15-30岁和40-60岁。平均年龄在性别上无差异(P0.05)。②女性患者中原发性自发性气胸(PSP)组的发病年龄明显低于继发性自发性气胸(SSP)组(P0.05)。③PSP组与SSP组的术后置管时间无差异(P0.05)。④PSP组的术后住院天数明显短于SSP组(P0.05)。⑤PSP组位于肺尖部的肺大疱所占比例要高于SSP组(P0.05)。⑥女性SP患者肺大疱切除标本中,ER的阳性率为97.06%(33/34),PR的阳性率为67.65%(23/34),CD10的阳性率为70.59%(24/34)。⑦ FLCN基因突变率,女性32.00%(8/25),男性9.90%(19/192),女性明显高于男性(P0.05)。结论：①对于自发性气胸的育龄期妇女,应考虑月经性气胸的可能,并依据其临床特点,借助辅助检查及内镜探查手段,特别是病理检测、免疫组化的鉴定,尽早明确诊断,予以合理治疗。②女性患者FLCN基因突变率明显高于男性患者,FLCN基因突变可能是女性PSP的主要致病因素之一。
[Abstract]:Objective: the sex difference of spontanous pneumothorax (SPI) in spontaneous pneumothorax (SPV) was significant. To analyze the expression of estrogen receptor (ERG), estrogen receptor (ERT), progesterone receptor (PR10), progesterone receptor (PR10) and FLCN folliculin gene mutation in female patients with SP, the clinical features of female SP patients were summarized. Methods: the clinical data of 834 patients (738 males and 96 females) in Nanjing chest Hospital affiliated to Southeast University from January 2011 to June 2015 were analyzed retrospectively. Including the patient's onset age, past history, emphasis on the presence of pneumothorax family disease, skin damage, kidney tumor, chronic obstructive pulmonary disease (Copd, pulmonary tuberculosis tuberculosis), and the side, location, size and shape of pulmonary bullae. The location of pulmonary bullous distribution, postoperative catheterization and hospitalization time were explored during operation. 34 female patients with SP were selected for immunohistochemical staining to evaluate the estrogen receptor in lung tissue. The expression of progesterone receptor and CD10 was detected in 217 patients (192 males and 25 females) with family history or highly suspected BHD syndrome. The age of onset of primary spontaneous pneumothorax in female patients with primary spontaneous pneumothorax was significantly lower than that in secondary spontaneous pneumothorax group (P 0.05). 3PSP group and SSP group had no difference in postoperative catheterization time. The postoperative hospitalization days in the P0.05PSP group were significantly shorter than those in the SSP group (P 0.05N 路5PSP group). The proportion of pulmonary bullae located at the tip of the lung in the P0.05PSP group was significantly higher than that in the female patients with pulmonary bullous excision in the SSP group. The positive rate of ER was 97.06% 33% 34 PR. The positive rate of CD10 was 70.5924% 34.7 FLCN gene mutation. Women 32.00 / 25, men 9.90 / 1922, women significantly higher than men P0.05.Conclusion for women of childbearing age with spontaneous pneumothorax, the possibility of menstrual pneumothorax should be considered, and according to its clinical characteristics, with the aid of auxiliary examination and endoscopic exploration, especially pathological examination, it is necessary to consider the possibility of menstrual pneumothorax in women with spontaneous pneumothorax. Immunohistochemical identification, early diagnosis and reasonable treatment of FLCN gene mutation in female patients were significantly higher than those in male patients, which may be one of the main pathogenetic factors of female PSP.
【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R561.4

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