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子宫内膜异位症患者血清中VEGF和ENA-78的检测及意义

The Concertrations and Significance of Serum VEFG and ENA-78 in Patients with Endometriosis

作者: 专业:妇产科学 导师:马楠 年度:2010 学位:硕士  院校: 郑州大学

Keywords

EMs, dysmenorrheal, VEGF, ENA-78, ELISA

        背景及目的子宫内膜异位症(endometriosis, EMs)是指具有生长功能的子宫内膜腺上皮细胞和间质细胞出现在子宫腔被覆粘膜以外的身体其它部位,以痛经、不孕、盆腔包块和性交痛为主要临床症状。该病是育龄女性的常见病,其发病率高达10-15%,且近年来有明显升高趋势。目前,该病的确切发病机制尚不十分明确,且其诊断的金标准主要来源于有创的腹腔镜检查,此外,该病治疗后的复发率较高,这给妇产科医生的诊断及治疗带来了很多的困惑。本实验通过检测子宫内膜异位症患者血清中血管内皮生长因子(Vascular endothelial growth factor, VEGF)和上皮细胞来源的中性粒细胞活化肽-78(epithelial neutrophil-activing peptide-78, ENA-78)的表达并分析其相关性,以探讨VEGF和ENA-78在EMs发生、发展中的关系,以期对EMs的临床诊断、治疗及预后评估起到一定的指导意义。此外,研究上述细胞因子在子宫内膜异位症患者血清中的表达和调节,可以以上述血管生成因子作为治疗的靶点,通过阻断新生血管的形成为子宫内膜异位症的治疗提供新方法。材料和方法以2008年6月至2009年6月在郑州大学第二附属医院妇科行腹腔镜或开腹手术治疗的患者为研究对象。术后病理诊断为子宫内膜异位症的患者为病例组。同期术后病理诊断为子宫肌瘤和因不孕而行腹腔镜检查或治疗的患者为对照组。所有患者术前均采取空腹静脉血,月经周期均为28天-35天。采用酶联免疫吸附方法(ELISA)检测两组患者血清中VEGF和ENA-78的水平。应用Excel 2000对VEGF和ENA-78的表达水平建立数据库,应用SPSS13.0软件对数据进行统计分析。以α=0.05为检验水准。结果1.子宫内膜异位症组患者血清中VEGF、ENA-78的浓度均明显高于对照组(P<0.05);2.Ⅲ、Ⅳ期患者血清中VEGF、ENA-78的浓度均高于Ⅰ、Ⅱ期患者(P<0.05);3.子宫内膜异位症患者血清VEGF与ENA-78存在显著的正相关关系(rp=0.572;P<0.05);4.子宫内膜异位症患者血清中VEGF、ENA-78的浓度与患者痛经的严重程度均无明显相关性(rp=0.043; rp=0.232; P>0.05);5.联合测定患者血清中VEGF和ENA-78的浓度,在诊断子宫内膜异位症中有较高的特异性(95%)。结论1.VEGF和ENA-78与子宫内膜异位症的发生及发展有关;2.VEGF和ENA-78在子宫内膜异位症患者血清中表达水平的高低无法反应患者痛经的严重程度;3.联合测定患者血清中VEGF和ENA-78的水平可能有助于子宫内膜异位症的诊断。
    Backgrounds and ObjectivesEndometriosis, which is defined as functioning of endometrial glandular epithelial cells and stromal cells growing somewhere else other than mocous membrane lining the uterine cavity, is a common diseases affecting 10-15% of the female population causing dysmenorrhea, infertility, pelvic pain,dyspareunia and so on. At present.The disease has brought a lot of confusions to the doctors of Obstetrics and Gynecology in diagnosis and treatment.Because its pathogenesis is not yet very clear, its gold standard for diagnosis is mainly from invasive laparoscopic examination and the rate of its recurrence is higher. In this study, the expression of VEGF (Vascular endothelial growth factor) and ENA-78 (epithelial neutrophil-activing peptide-78) in the serum of the patients with endometriosis are determined and the correlation between them is analyzed, in order to investigate the role of of VEGF and ENA-78 in the progression of endometriosis and obtain a guidance in the clinical diagnosis, treatment and prognosis of EMs. Furthermore, through researching on the above-mentioned factors’expression and regulation in endometriosis, a new method can be explored for the treatment of EMs by blocking formation of new blood vessels with the angiogenic factors as therapeutic targets. Materials and methodsRandomly selected the patients who have been laparoscopiced or laparotomied in Gynecology of the Second Affiliated Hospital of Zhengzhou Universiry from June 2008 to June 2009. The case group was patients whose pathology was diagnosed as endometriosis was diagnosed as after surgery.While the control group wes those pathology was diagnosed as uterine fibroids and the patients had laparoscopic examination or treatment for infertility over the same period. All patients’menstrual cycle were 28 days to 35 days and their fasting venous blood was taken before the operations. VEGF and ENA-78 concentrations were determined by ELISA.Database was established by Excel 2000 for VEGF and ENA-78 levels and all date were analyzed by SPSS13.0 statistical software,α<0.05 were considered to be significant.Results:①The expression levels of VEGF and ENA-78 in patients with EMs were significantly higher than those in the control group(P<0.05);②The expression levels of VEGF and ENA-78 in stageⅢandⅣwere significantly higher than those of stageⅠandⅡ(P<0.05);③The levels of serum VEGF were correlated positively with that of ENA-78 in women with EMs(rp=0.572 P<0.05);④The levels of serum VEGF and ENA-78 in patients with EMs were uncorrelated with the severity of dysmenorrhea(rp=0.043, rp=0.232,P>0.05;⑤Simultaneously testing the serum VEGF and ENA-78 levels for diagnosing endometriosis,the sensitivity was 56.3% and the specificity was 95.8%.Conclusions:1、The levels of VEGF and ENA-78 are correlated with the progression of endometriosis;2、The VEGF and ENA-78 levels are uncorrelated with the severity of dysmenorrhea;3、It may be valuable to detect the serum levels of VEGF and ENA-78 in diagnosing endometriosis.
        

子宫内膜异位症患者血清中VEGF和ENA-78的检测及意义

摘要4-6
Abstract6-7
论文部分 子宫内膜异位症患者血清中VEGF和ENA-78的检测及意义11-35
    引言11-13
    材料与方法13-16
        1.1 研究对象13
        1.2 主要试剂与仪器13-14
        1.3 实验方法14-15
        1.4 结果判断15
        1.5 诊断指标15
        1.6 统计学处理15-16
    结果16-23
        2.1 子宫内膜异位症组与对照组VEGF、ENA-78水平的比较16-17
        2.2 子宫内膜异位症患者血清中VEGF的表达水平与疾病严重程度的关系17-18
        2.3 子宫内膜异位症患者血清中ENA-78的表达水平与疾病严重程度的关系18-19
        2.4 子宫内膜异位症患者血清中VEGF与ENA-78的相关性分析19
        2.5 子宫内膜异位症患者血清中VEGF、ENA-78表达水平与痛经严重程度的相关性分析19-21
        2.6 联合检测血清中VEGF和ENA-78的水平在诊断子宫内膜异位症中的意义21-23
    讨论23-30
        3.1 子宫内膜异位症的病因23
        3.2 子宫内膜异位症与VEGF23-24
        3.3 子宫内膜异位症与ENA-7824-26
        3.4 子宫内膜异位症与痛经26-27
        3.5 血清中VEGF和ENA-78的联合检测在子宫内膜异位症诊断中的临床意义27-28
        3.6 VEGF和ENA-78作为子宫内膜异位症诊断指标存在的问题28-29
        3.7 有待解决的问题29
        3.8 治疗子宫内膜异位症的前景及展望29-30
    结论30-31
    附图31-32
    参考文献32-35
综述部分 血管生成因子在子宫内膜异位症发病中的作用研究进展35-56
    1 血管生成在子宫内膜异位症中的作用36
    2 血管生成因子与子宫内膜异位症36-49
    3 抗血管生成治疗子宫内膜异位症49-51
    参考文献51-56
后记部分56-58
    本文主要英文缩写56-57
    个人简历57
    硕士期间论文发表情况57-58
    致谢58
        下载全文需50


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