不同剂量雌激素对宫腔粘连分离术后卵巢功能及ESR1表达的影响

Effect of different dosages of estrogen on ovarian function and ESR1 expression after hysteroscopic adhesiolysis

目的:探讨不同剂量雌激素对宫腔粘连(intrauterine adhesions,IUA)患者卵巢功能的抑制作用及对子宫内膜组织中雌激素受体1(estrogen receptor 1,ESR1)表达的影响。方法:选取我院宫腔镜诊治中心接受宫腔粘连分离手术患者56例,术后随机给予戊酸雌二醇(estradiol valerate,EV)4 mg/d(23例)、6 mg/d(17例)、9 mg/d(16例)周期治疗3个疗程。经黄体期孕酮检测随访治疗中、停药次月患者卵巢排卵情况。用Western blot和q PCR检测其中EV 4 mg组和EV 9 mg组患者术前、术后3个月内膜ESR1表达。结果:56例IUA患者激素治疗期间排卵抑制率为:EV 4 mg组8.69%,EV 6 mg组58.82%,EV 9 mg组93.75%(P<0.05);停药次月排卵抑制率为EV 4 mg组4.34%,EV 6 mg组17.64%,EV 9 mg组56.25%(P<0.05)。经分层分组分析治疗后轻中度IUA组、重度IUA组、EV 4 mg组、EV 9 mg组内膜ESR1表达与治疗前相比均明显下降(P<0.05);仅重度IUA组中用EV9 mg治疗者ESR1表达下降幅度明显大于EV 4 mg者(P<0.05)。结论:雌激素治疗剂量越大对卵巢排卵抑制作用越强,而大剂量雌激素对降低内膜ESR1表达似乎无明显优势。

Objective:To study the effect of different dosages of estradiol valerate(EV)on ovarian function and estrogen receptor(ESR1)expression after hysteroscopic adhesiolysis in patients with intrauterine adhesions(IUA). Methods:Fifty-six patients suffered from IUA were recruited in our center of hysteroscopy,and treated by EV 4 mg(23 cases),EV 6 mg(17 cases),EV 9 mg(16 cases)and progesterone sequentially for three cycles therapy after hysteroscopic adhesiolysis. The patients were followed up the ovulation by detected progesterone hormone during and after treatment. Then,the patients' endometrial tissues in EV 4 mg and EV 9 mg groups were investigated for ESR1 expressions by Western blot and q PCR before and after treatment. Results:In 56 patients,the rates of ovulation inhibition rate was 8.69% in EV 4 mg,58.82% in EV 6 mg,93.75% in EV 9 mg during treatment respectively(P<0.05);the ovulation inhibition rate was 4.34% in EV 4 mg,17.64% in EV 6 mg,56.25% in EV 9 mg in the following month after treatment respectively(P<0.05). ESR1 expression was decreased significantly only in all groups after treatment with hierarchical grouping. ESR1 expression in falling range was significant in serious IUA group with EV 9 mg compared with that of EV 4 mg(P<0.05). Conclusion:The larger dosage of estrogen used,the more obviously ovulation inhibited. There was no significant advantage to decrease ESR1 expression with large dosage of estrogen.