145例子宫内膜异位症临床分析附s100a4cox2相关研究.pdf

上海交通大学 硕士学位论文 145例子宫内膜异位症临床分析（附S100A4，COX-2相关研究） 姓名：陈洁雯 申请学位级别：硕士 专业：妇产科 指导教师：狄文 20090420 145例子宫内膜异位症临床分析（附S100A4,COX-2相关研究） 摘 要 子宫内膜异位症虽是一种妇科良性疾病,但其临床发生率之高及症状 体征反复出现的生物学特点使之成为困扰妇科医师临床实践的一大难题， 其表现的粘连、疼痛、不孕和复发性，严重影响了中青年妇女的健康和生 活质量 有关子宫内膜异位症所引起的慢性盆腔疼痛日益受到妇产科医生 的广泛关注 本研究共分为两部分：①145例子宫内膜异位症临床资料分析② S100A4，COX-2与子宫腺肌病痛经症状相关性的研究 第一部分 145例子宫内膜异位症临床资料分析 【目的】对145例子宫内膜异位症患者进行回顾性临床资料分析，探讨发 病年龄分布，临床表现特点，痛经症状的相关临床因素，术式选择，术后 与术前症状比较及术后用药情况 【方法】随访2008年1月至2008年12月间在我院妇科经手术后病理检查确 诊为子宫内膜异位症患者共145例, 根据术中所见及标本病理检查结果分 为卵巢子宫内膜异位囊肿及子宫腺肌病两组。

所有患者均未绝经从患者 年龄分布，主要临床症状，分娩史和分娩方式，宫腔操作史，CA125数值， 手术方式，治疗效果及术后用药情况等进行临床分析，着重探讨痛经症状 的相关因素及治疗效果 【结果】145例患者中，77例为卵巢子宫内膜异位囊肿患者，68例为子宫 腺肌病患者巧囊组发病年龄低于腺肌病组，两组有显著性差异 （P0.05） COX-2蛋白在痛经患者中，阳性率72.73%,阴性率27.27% 无痛经患者中，阳性率44.44%，阴性率55.56%痛经组中COX-2阳性比例 高于无痛经组，但两组比较无统计学差异（P0.05） 【结论】 S100A4蛋白与子宫腺肌病痛经症状的发生可能无相关联系 COX-2 蛋白在伴有痛经症状的腺肌病的表达高于无疼痛组对COX-2拮抗剂的研 究可能为临床治疗子宫腺肌病痛经症状提供新途径和新思路 关键词 子宫内膜异位症，痛经，S100A4，COX-2，免疫组化 CLINICAL ANALYSIS OF 145 CASES OF ENDOMETRIOSIS (INCLUDING STUDY ON THE RELATIONSHIP BETWEEN S100A4,COX-2 AND DYSMENORRHEA IN ADENOMYOSIS) ABSTRACT The incidence of endometriosis is rising gradually. Although endometriosis is a kind of benign disease, the incidence of adhesion, dysmenorrhea, chronic pelvic pain, interfility and recurrence is puzzling women and gynecologists. More and more investigators pay attention to the mechanism of pelvic pain and dysmenorrhea caused by endometriosis. The study is divided into 2 parts as following: ①clinical analysis of 145 cases of endometriosis②study on the relationship between S100A4 ， COX-2 and the mechanism of dysmenorrhea in adenomyosis. Part I Clinical analysis of 145 cases of endometriosis 【OBJECTIVE】Clinical data of 145 cases of endometriosis was retrospectively analysed. Through these statistics ,We try to get more detailed information of endometriosis so that some new ideas and methods for healing endometriosis will be found. 【METHODS】We analysed clinical data of 145 patients who have been operated in gynecology department in Renji Hospital during January to December in 2008. All have been proved to be endometriosis by pathology. According to the pathology, they have been divided into 2 groups: group of endometrial cyst and group of andenomyosis. None of the patients are menopausal. Age, symptom and sign, the history of pregnancy, delivery and surgery, CA125, modus operandi, treatment effectiveness and medication after surgery were analysed. We put emphasis on finding out the correlated factors with dysmenorrhea and the treatment effectiveness. 【RESULTS】In 145 cases, 77 cases are proved to be endometrial cyst,68 cases are adenomyosis. The average age of group of endometrial cyst is younger than group of adenomyosis （P0.05）. 【CONCLUSIONS】To patients with adenomyosis, the symptoms of dysmenorrhea, progressive dysmenorrhea, menorrhagia are more severe than those with endometrial cyst. The incidence rate of dysmenorrhea of the endometrial cyst in left side is higher than in the right side. Surgery can relieve the symptoms of dymenorrhea. Age may be a key factor when gynecologists and patients decide which kind of modus operandi will be practiced in a case of adenomyosis. Part II Study on the relationship between S100A4，COX-2 and the mechanism of dysmenorrhea in adenomyosis 【OBJECTIVE】The study aims to investigate the relationship between S100A4 ,COX-2 and the mechanism of dysmenorrhea in adenomyosis. 【METHODS】Samples were collected and divided into 2 groups:group of adenomyosis with dysmenorrhea(11 cases) and group of adenomyosis without dysmenorrhea(9 cases). Immunohistochemistry were used to study the expression of S100A4 and COX-2 in ectopic endometrium.We compared the expression of S100A4 , COX-2 in ectopic endometrium in the 2 groups. 【RESULTS】There was no significant difference in the expression level of S100A4 protein between the group of adenomyosis with dysmenorrhea and the group without dysmenorrhea (P0.05).There was also no significant difference in the expression level of COX-2 protein between these 2 groups(P0.05),but the positive percentage in the group of adenomyosis with dysmenorrhea( 72.73%) is much more higher than that in the group without dysmenorrhea(44.44%). 【CONCLUSIONS】In the group of adenomyosis with dysmenorrhea, the expression level of COX-2 in ectopic endometrium may be higher than that in the group without dymenorrhea. S100A4 may have no relation to the mechanism of dymenorrhea in adenomyosis. KEY WORDS endometriosis,dysmenorrhea,immunohistochemistry, S100A4,COX-2 上海交通大学上海交通大学 学位论文原创性声明学位论文原创性声明 本人郑重声明：所呈交的学位论文，是本人在导师的指导下，独 立进行研究工作所取得的成果。

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