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研究生:周雪珠
論文名稱:隱匿性陰莖男童其雄性激素受體表現之研究
論文名稱(外文):Study of androgen receptor in boys with buried penis
指導教授:謝易修謝易修引用關係
指導教授(外文):Yih-Shou Hsieh, Ph. D.
學位類別:碩士
校院名稱:中山醫學院
系所名稱:生物化學研究所
學門:生命科學學門
學類:生物化學學類
論文種類:學術論文
論文出版年:2001
畢業學年度:89
語文別:中文
論文頁數:68
中文關鍵詞:雄性激素雄性激素受體隱匿性陰莖
外文關鍵詞:androgenandrogen receptorburied penis
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中文摘要
隱匿性陰莖乃是有正常的陰莖長度,但外觀上卻很小,甚至看不見。據歐美文獻報導此為少見的疾病,但根據我們自己的經驗,以及最近新加坡、中國大陸的報告,中國人發生率偏高。事實上隱匿性陰莖的變異有輕有重,雖然我們已瞭解其病理變化,但對其致病原因不甚明白。
罹患此病之病童有部分會隨成長而得到改善,但卻無法預知。此種疾病的病變只侷限在陰莖及週邊組織,而陰莖及週邊組織的發育與局部雄性激素受體有密切的關係。而且由以往其他疾病的經驗,雄性激素受體的問題可造成輕重不等程度的外生殖器官發育異常。因此,隱匿性陰莖與雄性激素受體表現之相關性是值得探討之問題,或可藉由此研究之結果推斷病變嚴重之程度及進行預後之評估。
過去兩年來我們利用免疫組織化學染色法、放射免疫分析法以及西方墨點分析法研究分別來自正常男童與隱匿性陰莖病童的包皮組織中雄性激素受體的活性與表現量。於免疫組織化學染色法的分析,依隱匿性陰莖病童組織染色結果的表現量與強弱將其分為四個等級;另由醫師將這些病患的病歷記錄,手術記錄,手術方法與時間,及生理檢查等做一回溯性病歷複查之臨床表徵判讀,同樣亦區分為四個等級,將兩組做一雙盲比對,經由Pearson chi-square test統計發現這兩組並沒有顯著的差異 (P = 0.57307, > 0.05),表示以免疫組織化學染色法所做的實驗是有意義的。同樣的染色方法,在57例正常男童的表現量皆遠較隱匿性陰莖的組別顯著。以西方墨點分析亦有相似的結果。
由此研究,我們證明了正常男童與隱匿性陰莖患童其雄性激素受體的表現量有顯著的差異,且雄性激素受體的表現量與隱匿性陰莖疾病間有高度的負相關性存在。

ABSTRACT
Buried penis is a congenital abnormality in which the phallus is concealed within the surface of prepubic skin. It has been described as a rare condition by some authors, but it is probably more common than has been appreciated. This condition may be more frequently seen in ethnic Chinese, although the etiology is still unknown.
The androgen receptor (AR) is a member of the steroid receptor family of nuclear transcription factors, whose action requires the binding of ligand. AR is found ubiquitously throughout mammalian tissues, implying that androgens have diverse roles not only in development and maintenance of male sexual function, but also in many other sexually dimorphic processes. Disorders of androgen receptor function cause a spectrum of phenotypic abnormalities. The present study attempted to investigate the relationship between the quality and quantity of androgen receptor at penile skin and buried penis.
Past two years, we used the immunohistochemical (IHC) staining, radio-immuno assay (RIA) and Western blotting analysis to study the activity and amount of androgen receptor in the prepuce of both normal children and the children with buried penis. We classified our total study population of 33 patients with buried penis into four groups based on the expression levels of AR by IHC staining. Surgical management of these patients were also classified into four groups based on clinical indications and physical examinations. A comparison between the IHC stain and surgical management as disclosed by a retrospective chart review showed that the IHC stain matched the surgical management in each group (P = 0.57307, > 0.05). A control group of 57 boys with phimosis had more intensive and clear staining than that of patients with buried penis by IHC stain study. A similar result was obtained using Western blotting analysis. Our study has proved that the amount of androgen receptor in the prepuce of normal children is significantly higher than that in the children with buried penis. We also found that the amount of androgen receptor is negatively correlated with the spectrum of phenotypic abnormalities of phallus in children with buried penis.

目 錄
目錄 1
表、圖目錄 2
中文摘要 3
英文摘要 5
縮寫表 7
前言 8
研究動機 21
實驗設計大綱 22
材料與方法 23
結果 29
討論 32
參考文獻 36
表、圖目錄
圖一:Classification of inconspicuous penis 46
圖二:不同病變程度的隱匿性陰莖患童之臨床表徵 47
圖三:隱匿性陰莖患童在解剖學上的肇因 48
圖四:隱匿性陰莖患童的臨床表徵 49
圖五:The AR gene, structural and functional domains 50
圖六:Molecular mechanism of AR action 51
圖七:隱匿性陰莖與正常陰莖之外觀比較圖 52
圖八:實驗之材料來源 (正常陰莖及包皮之解剖圖) 53
表一:33例隱匿性陰莖患童手術年齡及免疫組織染色的判讀 54
表二:33例隱匿性陰莖患童手術年齡及回溯性病歷複查之臨床
表徵判讀 55
表三:57例正常男童包皮環切手術的年齡及臨床診斷 56
表三:57例正常男童包皮環切手術的年齡及臨床診斷(續) 57
圖九:正常男童與隱匿性陰莖患童手術年齡之分佈圖 58
圖十:不同臨床表徵之隱匿性陰莖患童以免疫組織染色判讀與
回溯性病歷複查判讀之比較圖 59
圖十一:三例正常男童陰莖之包皮組織在IHC stain的表現 60
圖十二:二例正常男童陰莖之包皮組織在IHC stain的表現 61
圖十三:三例嚴重型隱匿性陰莖患童之包皮組織在IHC stain的表現 62
圖十四:不同臨床表徵的隱匿性陰莖患童在IHC stain的表現 63
圖十五十九:正常男童與隱匿性陰莖患童其包皮組織內雄性
激素受體在西方墨點分析之表現 64

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