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研究生:楊士維
研究生(外文):Shih Wei Yang
論文名稱:人類乳突病毒在人類口腔白斑癌化過程中所扮演的角色以及其它相關因子之統計分析及探討
論文名稱(外文):THE ROLE OF HUMAN PAPILLOMAVIRUS IN THE PROCESS OF MALIGNANT TRANSFORMATION OF ORAL LEUKOPLAKIA AND LOGISTIC REGRESSION ANALYSIS OF ASSOCIATED RISK FACTORS
指導教授:蔡七女
指導教授(外文):Chi Neu Tsai
學位類別:碩士
校院名稱:長庚大學
系所名稱:臨床醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
論文頁數:69
中文關鍵詞:人類乳突病毒白斑惡性轉變鱗狀上皮細胞癌
外文關鍵詞:human papillomavirusleukoplakiamalignant transformationsquamous cell carcinoma
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本篇研究論文的目的是研究人類乳突病毒在人類口腔白斑癌化過程中所扮演的角色以及其它相關因子之探討。口腔白斑臨床上普遍認為是口腔黏膜轉變成口腔鱗狀上皮細胞癌的癌前病變,許許多多的危險因子在之前的研究已被提出認為和癌化過程有相關連,而人類乳突病毒也被認為是有可能之致病因子。然而,鮮少有研究報告指出同時分析同一病患從白斑轉成鱗狀上皮細胞癌這兩個階段人類乳突病毒之感染狀態以及型別。是故,在這份研究報告中,我們蒐集了口腔白斑轉變成口腔癌之病例,將人類乳突病毒以其型別、病患之臨床基本資料、病灶外觀及分佈情形、和病理組織特性等因子進行統計分析,探討這些因子,包括人類乳突病毒,在癌化過程中所扮演之角色。
本研究乃是從石蠟包埋的蠟塊中將檢體先行處理後,人類乳突病毒基因組之去氧核糖核酸例用聚合酶連鎖反應(PCR),利用MY09/MY11引子先做第一次PCR反應,再利用第二個引子GP05+/GP06+做第二次的PCR,以增加病毒基因組之偵測比例。偵測到去氧核糖核酸後,再利用自動排序之機台測得人類乳突病毒之型別。統計分析分法則是利用Fisher’s exact test以及多變數廻歸分析logistic regression,找出口腔白斑癌化之可能相關因子。
結果顯示共有167位口腔白斑病患進入本次之研究,其中12位病患轉變成口腔癌。人類乳突病毒在22.8%的病患中呈現陽性。口腔白斑癌化的危險因子為手術後白斑復發(p = 0.03),人類乳突病毒感染並非有意義的相關因子。在這12位病例上,人類乳突病毒型別的分佈亦不一致,真正發生癌變的可能原因應是病患本身抽煙、飲酒或嚼食檳榔之習慣所致。
本研究資料結論為人類乳突病毒並非口腔白斑惡性變化之致病因子。
Oral leukoplakia is considered as a premalignant lesion for the development of oral squamous cell carcinoma (OSCC); several risks factors have been reported to contribute to this step-wise carcinogenesis; including human papillomavirus (HPV). Nevertheless, few reports have analyzed both the HPV status and the genotype in a single individual who develops OSCC from pre-existing oral leukoplakia. In this study, we surveyed the HPV status, genotype and clinicopathological risk factors in cases of malignant transformation from pre-existing oral leukoplakia.
HPV genomic DNA was detected by PCR (MY09/MY11 in conjugation with nested primer-GP05+/GP06+) from paraffin sections, and the genotype was determined by direct DNA sequencing. Fisher’s exact test and logistic regression were used to analyze risk factors for malignant transformation of oral cavity leukoplakia.
One hundred and sixty-seven patients with oral leukoplakia were enrolled; including 12 who had malignant transformation from the pre-existing oral leukoplakia. HPV prevalence was 22.8% in cases with oral leukoplakia. The risk factor associated with malignant transformation was recurrence of leukoplakia after treatment (p = 0.03), nevertheless, HPV status was not statistically significant by logistic regression analysis. Among these 12 patients with malignant transformation from pre-existing oral leukoplakia, the status or genotype of HPV was chaotic; the oral habits of these patients might contribute to malignant transformation.
Our data suggest that HPV in oral leukoplakia is no prognostic indicator of malignant transformation.
CHAPTER I Introduction
1.1 Background…………………………………………………….1
1.2 Review of Related Studies………………………………3
1.3 Objective of the Study………………………………….5
CHAPTER II Experimental Setup
2.1 Material, Patients and Sample Collection…………….6
2.2 Methods………….……………………………………………....7
2.2.1. DNA Extraction……………………….………………....7
2.2.2 HPV Detection and Genotype Analysis………………..8
2.2.3 Immunohistochemical Staining…………………………9
2.2.4. Statistical Analysis…………………………………….9
CHAPTER III Experimental Results
3.1. The HPV Detection Rate…………………….……...11
3.2 The Statistical Analysis of the Role of HPV and Other Associated Risk Factors ……………………………………..11
CHAPTER IV Discussion……………………………………………14
CHPATER V Conclusions………………………….…………………22
CHAPTER VI Future Works…………………………………………23
Table 1………………………………………………………………..24
Table 2……………………………………………….……………..25
Table 3………………………………………….…………………..26
Table 4………………………………………….…………………..28
Table 5……………………………………….……………………..29
Figure 1…………………………………….……………………….31
Figure 2………………………………….………………………….32
Figure 3……………………………….…………………………….33
Figure 4…………………………………….……………………….34
Figure 5…………………………………….……………………….35
Figure 6…………………………………….……………………….36
REFERENCES……………………….………………………………..37
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