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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2013, Vol. 09 ›› Issue (05) : 589 -593. doi: 10.3877/cma.j.issn.1673-5250.2013.05.004

所属专题： 文献；

论著

高强度聚焦超声治疗女性外阴上皮内非瘤样病变组织的雌、孕激素受体及生存素表达及意义
尹格平1,*,*(), 武爱芳1, 梁静1, 支圆圆1   
  1. 1. 250031　山东济南，济南军区总医院妇产科
  • 收稿日期:2013-06-21 修回日期:2013-08-27 出版日期:2013-10-01
  • 通信作者: 尹格平

Expression of Survivin, Estrogen and Progesterone Receptor in Focal Tissues Before and After Treatment by High Intensity Focused Ultrasound for Nonneoplasia Epithelial Disorders of Skin and Mucosa of Vulva

Ge-ping YIN1(), Ai-fang WU1, Jing LIANG1, Yuan-yuan ZHI1   

  1. 1. Department of Gynecology, Jinan Millitary General Hospital, Jinan 250031, Shandong Province, China
  • Received:2013-06-21 Revised:2013-08-27 Published:2013-10-01
  • Corresponding author: Ge-ping YIN
  • About author:
    (Corresponding author: YIN Ge-ping, Email: )
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尹格平, 武爱芳, 梁静, 支圆圆. 高强度聚焦超声治疗女性外阴上皮内非瘤样病变组织的雌、孕激素受体及生存素表达及意义[J/OL]. 中华妇幼临床医学杂志(电子版), 2013, 09(05): 589-593.

Ge-ping YIN, Ai-fang WU, Jing LIANG, Yuan-yuan ZHI. Expression of Survivin, Estrogen and Progesterone Receptor in Focal Tissues Before and After Treatment by High Intensity Focused Ultrasound for Nonneoplasia Epithelial Disorders of Skin and Mucosa of Vulva[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2013, 09(05): 589-593.

目的

探讨高强度聚焦超声(HIFU)治疗女性外阴上皮内非瘤样病变(NEDV)组织中雌激素受体(ER)、孕激素受体(PR)及生存素(survivin)的表达及意义。

方法

收集2009年1月至2011年9月在本院诊治，并经组织病理学标本检查证实为NEDV的患者86例为研究对象。其年龄为15～75岁，平均为(43.0±14.5)岁。对其按照NEDV组织病理学标准进行分类：鳞状上皮细胞增生型(SHV)为43例，硬化性苔癣型(LSV)为29例，硬化性苔癣合并鳞状上皮细胞增生型(LSCSH)为14例。采取HIFU治疗前，对86例患者的病灶标本进行组织活检，并随机采集30例患者的病灶周围正常皮肤组织进行活检；治疗6个月后复检。采用免疫组织化学法检测病变组织中ER，PR及survivin的表达水平。采取"外阴瘙痒评分法"、"外阴白色病变面积计算法"和"四度皮肤弹性评估法"判断HIFU治疗的客观疗效(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，征得受试对象本人的知情同意，并与之签署临床研究知情同意书)。

结果

86例患者于HIFU治疗结束后6个月时，①采用"外阴瘙痒法"进行疗效判断的有效率为100%，同时白色病变面积由(11.21±7.50) cm2缩小为(6.60±3.17) cm2，外阴瘙痒评分降低率与白色病变区面积缩小率与治疗前比较，差异均有统计学意义(P<0.01)。②ER，PR与survivin在SHV型，LSV型及LSCSH型的表达水平与治疗前比较，差异无统计学意义(P>0.05)。HIFU治疗前，ER，PR在正常外阴组织中的阳性表达率显著高于病变组织，survivin则显著降低，差异均有统计学意义(P<0.05)。③ER，PR在局部组织中的表达水平较治疗前明显增加，survivin则明显降低，差异均有统计学意义(P<0.05)。

结论

survivin在NEDV组织表达增高，而ER，PR表达降低，这可能与NEDV发病有关。HIFU治疗前、后，根据ER，PR及survivin在NEDV组织的表达情况，可判断疗效。

关键词: 高强度聚焦超声, 外阴上皮内非瘤样病变, 致病机制, 疗效, 雌/孕激素受体, 生存素
Objective

To investigate the expression levels and significance of estrogen receptor(ER), progesterone receptor (PR) and survivin in the focal tissues of non-neoplasia epithelial disorders of skin and mucosa of vulva(NEDV) before treatment and after 6 months of treatment by high intensity focused ultrasound(HIFU).

Methods

From January 2009 to September 2011, a total of 86 cases with NEDV, in an average age of (43.0±14.5) years old (15 to 75 years old), confirmed by biopsy pathology before treatment by HIFU, and 30 patients were randomly obtained the normal tissues nearby the focuses for control. According to histological classification of NEDV, 86 patients with NEDV were divided into three pathological types.Types of squamous hyperplasia(SHV)were 43 cases, lichen sclerosus(LSV)were 29 cases, and lichen sclerosus combined with squamous hyperplasia(LSCSH)were 14 cases.Immunohistochemical analysis for survivin, ER and PR expression were carried out on the tissue samples collected before treatment and after 6 months of treatment by HIFU. The methods of Vulvar Pruritus Score, Vulvar Leucoplakia Area Calculation and Vulvar Skin Elasticity were designed for objective evaluation of curative effect. Informed consent was obtained from all participants.

Results

After 6 months of treatment by HIFU, ① the curative rate of relieving-pruritus was 100%, and the average areas of vulvar leucoplakia of 86 patients with NEDV decreased from (11.21±7.50) cm2 to (6.60±3.17) cm2, and there were statistically more effective for Vulvar Pruritus Score and Vulvar Leucoplakia Area Calculation than those before treatment by HIFU(P<0.01). ②Expression levels of survivin, ER, and PR before treatment and after 6 months of treatment by HIFU, there had no statistical difference among the three pathological types: SHV, LSV and LSCSH(P>0.05), respectively. Positive rates of ER and PR expression before treatment and after 6 months of treatment by HIFU in normal vulvar tissues were much higher than those of focus tissues(P<0.05), but the survivin were much lower(P<0.05). ③Positive rates of ER and PR expression after 6 months of treatment by HIFU in focal tissues became much higher, as well as the surviving much lower than those before treatment by HIFU(P<0.05).

Conclusions

Expression levels increasing of survivin and decreasing of ER and PR could be the essential factors of pathogenesis for NEDV. Expression levels of survivin, ER and PR may play an important role in indicate the curative effect.

Key words: high intensity focused ultrasound, non-neoplasia epithelial disorders of skin and mucosa of vulva, pathogenesis, curative effect, estrogen/progesterone receptor, survivin
表1 研究组治疗前与治疗6个月时外阴瘙痒评分比较(分，±s)
Table 1 Comparison of vulvar pruritus scores before treatment and after 6 months of treatment in research group(score，±s)
组织学类型 n 评分 治愈率[n(%)] t P
治疗前 治疗后6个月时
SHV 43 2.60±0.44 0.47±0.54 84.1(37/44) 2.857 <0.01
LSV 29 2.86±0.51 0.90±0.38 85.3(29/34) 3.184 <0.01
LSCSH 14 2.56±0.44 0.87±0.28 75.0 (6/8) 3.631 <0.01
合计 86 2.67±0.48 0.56±0.36 83.7(72/86) 2.731 <0.01
表2 研究组治疗前与治疗结束后6个月时外阴白色病变皮肤面积的比较(cm2，±s)
Table 2 Comparison of vulvar leucoplakia area calculation before treatment and after 6 months of treatment in research group(cm2，±s)
组织学类型 n 白色病变面积 治愈率[n(%)] t P
治疗前 治疗后6个月时
SHV 43 12.90±6.60 3.67±1.61 77.3(34/44) 4.971 <0.01
LSV 29 10.66±3.77 4.87±1.45 58.8(20/34) 3.290 <0.01
LSCSH 14 10.99±5.34 3.87±0.28 62.5 (5/ 8) 3.321 <0.01
合计 86 11.21±7.50 6.60±3.17 68.6(59/86) 2.836 <0.01
表3 研究组治疗前与治疗后6个月时外阴皮肤弹性评分比较(分，±s)
Table 3 Comparison of vulvar skin elasticity before treatment and after 6 months of treatment in research group(score，±s)
组织学类型 n 皮肤弹性评分 有效率[n(%)] t P
治疗前 治疗后6个月时
SHV 43 0.79±0.39 0.57±0.32 53.5(23/43) 1.933 >0.05
LSV 29 2.15±0.55 0.89±0.37 72.4(21/29) 3.291 <0.01
LSCSH 14 2.42±0.74 1.37±0.48 78.6(11/14) 3.291 <0.01
合计 86 2.07±0.57 0.84±0.30 64.0(55/86) 2.182 <0.05
表4 研究组治疗前与治疗结束后6个月时3种类型外阴病变组织及其与对照组ER，PR及survivin表达水平比较 (%)
Table 4 Comparison of expression of ER, PR and survivin in focal tissues before treatment and after 6 months of treatment by HIFM among types of SHV, SHV, LSV, LSCSH in research group and in control group (%)
组别 n ER (n) 阳性率 PR (n) 阳性率 survivin (n) 阳性率
－ ＋ ≥2＋ － ＋ ≥2＋ － ＋ ≥2＋
研究组SHV 43 ? ? ? ? ? ? ? ? ? ? ? ?
? 治疗前 ? 33 5 5 23.3 35 4 4 18.6 28 9 6 34.9
? 治疗后 ? 23 9 11 46.5 26 8 9 39.5 40 2 1 7.0
? χ2 ? ? ? ? 5.119 ? ? ? 4.586 ? ? ? 10.118
? P ? ? ? ? 0.024 ? ? ? 0.033 ? ? ? 0.001
研究组LSV 29 ? ? ? ? ? ? ? ? ? ? ? ?
? 治疗前 ? 24 2 3 17.2 25 2 2 29.4 20 5 4 31.0
? 治疗后 ? 17 6 6 41.4 18 5 6 37.9 27 1 1 6.9
? χ2 ? ? ? ? 4.077 ? ? ? 4.406 ? ? ? 5.497
? P ? ? ? ? 0.043 ? ? ? 0.036 ? ? ? 0.019
研究组LSCSHa 14 ? ? ? ? ? ? ? ? ? ? ? ?
? 治疗前 ? 10 2 2 28.6 11 2 1 21.4 9 3 2 35.7
? 治疗后 ? 6 4 4 57.1 7 4 3 50.0 13 1 0 7.1
? P ? ? ? ? 0.252 ? ? ? 0.236 ? ? ? 0.169
研究组 86 ? ? ? ? ? ? ? ? ? ? ? ?
? 治疗前 ? 67 9 10 22.1 71 8 7 17.4 55 17 14 37.2
? 治疗后 ? 46 19 21 46.5 41 27 18 52.3 80 4 2 7.0
? χ2 ? ? ? ? 11.377 ? ? ? 23.036 ? ? ? 21.522
? P ? ? ? ? 0.001 ? ? ? 0.000 ? ? ? 0.000
研究组治疗前 86 67 9 10 22.1 71 8 7 17.4 55 17 14 37.2
? 对照组 30 14 7 9 53.3 19 5 6 36.7 30 0 0 0.0
? χ2 ? ? ? ? 10.303 ? ? ? 4.727 ? ? ? ?
? P ? ? ? ? 0.001 ? ? ? 0.03 ? ? ? ?
研究组治疗后 86 46 19 21 46.5 41 27 18 52.3 80 4 2 7.0
? 对照组 30 14 7 9 53.3 19 5 6 36.7 30 0 0 0.0
? χ2 ? ? ? ? 0.414 ? ? ? 2.184 ? ? ? ?
? P ? ? ? ? 0.520 ? ? ? 0.924 ? ? ? ?
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