【作者】 李艳；

【导师】 薛凤霞； 刘姝华；

【作者基本信息】 天津医科大学 ， 妇科肿瘤， 2003， 硕士

【摘要】 目的： 探讨绝经后子宫肌瘤的临床病理特征，比较绝经后非萎缩子宫肌瘤与绝经后萎缩性肌瘤及增生期、分泌期肌瘤中生长因子及细胞外基质表达的差异，为绝经后非萎缩肌瘤的病因学研究提供一定的实验依据。 第一部分：绝经后子宫肌瘤临床病理特征的研究 采用回顾性病例分析方法将以子宫肌瘤为第一主要诊断住院、手术并经病理学证实的78例绝经后子宫肌瘤患者作为A组，其中包括天津医科大学总医院1992年1月～2001年12月近十年间收治的38例患者及中心妇产科医院2000年5月～2002年5月两年间收治的40例患者；同时随机选取总医院1997～2002年间因子宫脱垂，荒腔脓肿及单纯性卵巢囊肿手术而发现的绝经后萎缩性子宫肌瘤患者20例作为B组，比较两组的临床病理特征，结果如下： 1．绝经后以子宫肌瘤为第一诊断住院、手术治疗并经病理学确诊的患者占同期所有以子宫肌瘤住院患者的2.86％。 2．A组平均年龄为56.79岁，平均绝经时间为6.34年。 3．两组患者的初潮年龄，婚育情况及绝经年龄均无显著性差异。 4．两组患者伴发疾病及家族史情况均无显著差异。 5．A组患者最主要临床表现是绝经后不规则阴道出血，其次为压迫症状。 6．A组62.8％的患者绝经前无肌瘤病史，而是绝经后因肌瘤引起症状或查体发现。 7．两组患者血清中E2、P水平均无显著性差异。 8．A组术前误诊率高达23.1％，易被误诊为平滑肌肉瘤和卵巢肿瘤。硕士研究生学位论文中文摘要9.病理情况:A组19.2%的病理类型为富于细胞性平滑肌瘤，B组均为普通性 平滑肌瘤。两组内膜的变化一致，均表现为萎缩性内膜、退行性增殖或不规 则增生。两组肌瘤间或肌壁间的变性率无显著性差异，但两组肌瘤变性率均 显著高于相应肌壁(P<0.05);A组肌瘤中核分裂像计数八OHPF显著高于B 组(P<0 .05);A、B两组肌瘤中核分裂像计数/l OHPF均显著高于相应肌壁 (P值均<0.05)，A组肌瘤的生长活性相对较高。10.治疗:A组患者多采取全子宫及双附件切除术。第二部分:绝经后子宫肌瘤中IGF-I、IGF一IR、TGF一阶及FN表达的研究 应用免疫组化SP法检测不同月经状态的117例肌瘤及其相应肌壁中IGF一I、IGF一IR、TGF一p3和FN的表达情况。其中绝经后非萎缩肌瘤组57例，绝经后萎缩性肌瘤组20例、增生期20例及分泌期20例。分析各组肌瘤和肌壁中各指标的表达情况及其相互关系，结果如下:1.IGF一I在各组肌瘤和肌壁的表达 绝经后非萎缩肌瘤、萎缩性肌瘤及其相应肌壁中IGF一I的表达水平均显著低于增生期和分泌期相应组织(P值均<0.01)，表明IGF一I的表达受性激素影响。绝经后非萎缩肌瘤中IGF一I的表达显著高于萎缩性肌瘤(P<0 .05)，但两组肌壁间IGF一IR的表达水平无显著性差异;绝经后非萎缩肌瘤同绝经前肌瘤一样，肌瘤中IGF一I的表达均显著高于相应肌壁(P<0.01)，但萎缩性肌瘤与相应肌壁无明显差别，提示虽然绝经后肌瘤和肌壁中IGF一I的表达较绝经前显著下降，但绝经后非萎缩肌瘤中IGF一I的含量较萎缩性肌瘤显著升高，表明绝经后肌瘤局部自分泌较高水平的IGF一I可促进其生长。2.IGF一IR在各组肌瘤和肌壁的表达 绝经后非萎缩肌瘤、萎缩性肌瘤及其相应肌壁中IGF一IR的表达与绝经前相比均有下降趋势，表明其表达可能受性激素的影响。绝经后非萎缩肌瘤及相应肌壁中IGF一IR的表达均显著高于绝经后萎缩性肌瘤组相应组织(P<0.05);绝硕士研究生学位论文中文摘要经后非萎缩肌瘤与增生期肌瘤相比IGF一IR的表达水平无明显差别，而萎缩性肌瘤则显著低于增生期肌瘤(P<0.01)，并且提示绝经后肌瘤自分泌/旁分泌较高水平的IGF一IR与其生长有关。3.TGF一p3在各组肌瘤和肌壁的表达 绝经后非萎缩肌瘤及萎缩性肌瘤中TGF一p3的表达无显著差别(P=0.061)，但均显著低于增生期和分泌期肌瘤(P值均<0 .01)。绝经后非萎缩肌瘤同增生期和分泌期肌瘤一样，肌瘤中TGF一p3的表达均显著高于相应肌壁(P值均<0 .01)，而绝经后萎缩性肌瘤中TGF一那的表达与相应肌壁无明显差异。表明TGF一p3是绝经后肌瘤生长的另一重要因素。4.FN在各组肌瘤和肌壁的表达 绝经后非萎缩肌瘤及其相应肌壁中FN的表达与其它各组相应组织无明显差别。绝经后非萎缩肌瘤及增生期肌瘤中FN的表达均显著高于相应肌壁 (P<0 .05)，而绝经后萎缩性肌瘤中FN的表达与相应肌壁无明显差别。结果表明肌瘤中FN的表达可能不受性激素影响，其表达的增多可能是绝经后肌瘤不萎缩的原因之一。5.IGF一I与IGF一IR之间的关系 IGF一I与IGF一IR在各组肌壁及绝经后萎缩性肌瘤中的表达均呈正相关(P值均<0.05)，而绝经后非萎缩肌瘤、增生期及分泌期肌瘤中二者的表达无相关性。6.ToF一p3与IoF一I、IoF一IR及FN之间的关系 不考虑月经状态，肌瘤中TGF一阳与IGF一I、IGF一IR的表达均呈正相关(P值均<0.01)，但在肌壁中仅与IGF一I正相关(P<0.05)，与IGF一IR无相关性。提示TGF一p3作用的发挥可能受其它生长因子的影响，与IGF一I更多还原

【Abstract】 Uterine leiomyoma are the most common benign tumor in femal genital tract.Steroids hormone are promoters of leiomyoma growth. Traditionally, the majority of them regress after menopause, but some of them have no reduction in tumor size, and even cause symptoms. Recently, investigators have suggested that some peptide growth factors and their receptors maybe important in regulation of leiomyoma growth. The aims of this study were to investigate clinico-pathological characteristics of postmenopausal patients with leiomyoma and the expression of IGF-I, IGF-IR, TGF-β3, and FN in premenopausal and postmenopausal leiomyoma. Part I A Study on Clinico-Pathological Characteristics in Postmenopausal Patients with Symptomatic LeiomyomaIn this study, clinico-pathological characteristics of 98 cases were investigated, including 38 postmenopausal patients with symptomatic leiomyoma from 1992 to2001 in the general hospital and 40 cases from 2000 to 2002 in the central hospitalof gynecology and obstetrics (group A), and 20 postmenopausal patients with regressive leiomyoma from 1997 to 2002 in the general hospital (group B). All patients had no history of hormone replacement treatment within 3 months, and menopaused at least one year earlier. The results as follow:1. The percentage of postmenopausal patients with symptomatic leiomyoma was 2.86% of all the inpatients with leiomyoma during the same time in the generalhospital.2. Mean age at time of diagnosis was 56.79 years in group A. Mean duration of postmenopause of group A was 6.34 years.3. No differences were shown in mean age of menarche, marriage, menopause, and childbearing history.4. The most common symptom of patients in group A was irregular vaginal bleeding.5. No significant difference between group A and B was present either for serum estradiol or progesterone level.6. The misdiagnosis rate was 23.1% in group A. The leiomyoma of group A were misdiagnosed as uterine sarcoma or ovarian tumor commonly.7. 19.2% leiomyoma of group A were cellular leiomyoma, all of group B were common leiomyoma. The change of endometrium in group A and B was similar. No difference was shown in the rate of degeneration in leiomyoma or myometrium between group A and B. The rate of degeneration in leiomyoma was higher than that in the corresponding myometrium in the two groups.8. The majority of group A were treated by hysterectomy with bilateral oophorosalpingectomy.Part II A Study on Expression of IGF-I, IGF-IR, TGF-β3, and FN in LeiomyomaThe expression of IGF-I, IGF-IR, TGF-β3, and FN in 117 cases were examined by immunohistochemical technique, including 57 cases with symptomatic postmenopausal leiomyoma, 20 cases with regressive postmenopausal leiomyoma, 20 cases of proliferative phase, and 20 cases of secretory phase of menstrual cycle, named as group A, B, C , and D respectively. The relationships among expression ofIGF-I, IGF-IR, TGF-β3, and FN were analyzed. The results as follow: 1. The expression of IGF-IThe expression level of IGF-I in leiomyoma and myometrium of group A and B was significantly lower than that of group C and D (P<0.01 for all). The expression level of IGF-I in leiomyoma of group A was significantly higher than group B (P<0.05); the expression level of IGF-I in leiomyoma was significantly higher than that in the corresponding myometrium in group A (P<0.01), but no difference was shown in group B. The expression level of IGF-I appear to decrease in trend after menopause, but autocrined IGF-I in the leiomyoma was beneficial to the growth of symptomatic postmenopausal leiomyoma.2. The expression of IGF-IRThe expression level of IGF-IR appeared a trend to decrease in leiomyoma and myometrium from premenopause to postmenopause. The expression level of IGF-IR in group A was significantly higher than that in group B both in leiomyoma and myometrium (P<0.05). No significant difference between expression level of IGF-IR of group A and C was present, but signi更多还原