芳香酶P450与雌激素受体在子宫内膜异位症患者在位及异位子宫内膜中的表达及其相关性研究

Expressions of aromatase P450 and estrogen receptor in eutopic and ectopic endometrium in endometriosis and their correlation with endometriosis

目的 探讨芳香酶P450和雌激素受体 (ER)在子宫内膜异位症 (内异症 )患者在位内膜与不同部位异位内膜中的表达及其相关性。方法 收集 40例根据美国生育学会“修订的子宫内膜异位症分期法”分期为Ⅲ、Ⅳ期的内异症患者经手术切除的组织标本 83份,按内异症发生部位的不同分为 5组:内异症患者在位子宫内膜 25份 (Ⅰ组 );内异症患者位于卵巢的异位子宫内膜 23份(Ⅱ组);取自阴道直肠隔的异位内膜 11份(Ⅲ组);取自腹壁切口的异位内膜 8份 (Ⅳ组);取自子宫浆膜层的异位内膜 16份(V组)。对照组为正常子宫内膜 20份,取自同期门诊 20例行宫内节育器放置术的正常育龄妇女。采用免疫组织化学方法测定各组内膜组织腺细胞中芳香酶P450和ER的表达,根据阳性率和表达强度进行量化评分(组织化学评分),并进行相关性分析。结果 (1)Ⅰ组腺细胞芳香酶P450和ER的表达 [分别为 ( 2.6±1.0 )分、( 3.8±0.5 )分 ]均显著高于对照组 [分别为(0.8±1.1)分、(1 3±1 3)分],两组比较,差异有统计学意义(P均<0.01)。(2)Ⅱ组腺细胞芳香酶P450和ER的表达[分别为(1 4±1.0)分、(1.9±1.6)分]显著低于Ⅰ组,两组比较,差异有统计学意义(P分别<0.05、<0.01)。(3)Ⅲ组腺细胞芳香酶P450和ER的表达 [分别为 (1.2±0.9)分、(1.8±1.6)

Objective To detect the expression of aromatase P450 and estrogen receptor (ER) in eutopic and ectopic endometrium in endometriosis and their correlation with endometriosis. Methods Forty patients who had undergone operation because of endometriosis (all were stage Ⅲ-Ⅳ according to the revised American Fertility Society classification) were enrolled and 83 tissue specimens from different locations of disease foci were obtained and divided into five groups according to the location: group Ⅰ, eutopic endometrium of 25 cases; Group Ⅱ, ovarian endometriosis tissues of 23 cases; Group Ⅲ, vagina-rectum endometriosis tissues of 11 cases; Group Ⅳ, peritoneum endometriosis tissues of eight cases; and group V, uterine serosa endometriosis tissues of 16 cases. Control group consisted of normal endometrium taken from 20 fertile women who had endometrial curettage before placement of intrauterine device. The routine two-step immunohistochemical technique was used to measure the expression of aromatase P450 and ER in endometrial cells. Results Expressions of aromatase P450 and ER in group Ⅰ [histochemistry score (H-score), 2.6±1.0, 3.8±0.5] were significantly higher than those in control group (both P<0.01), group Ⅱ (1.4±1.0, 1.9±1.6) (P<0.05, P<0.01), and group Ⅲ(1.2±0.9,1.8±1.6) (both (P<)0.05). Expressions of aromatase P450 and ER had positive correlation in all groups(r=0.577,P<0.01). Conclusions Aromatase P450 could increase estrogen and estrogen receptor levels in the local ectopic tissues, thus promoting the growth and implantation of endometriosis. Different types of endometriosis focus have different levels of hormone regulation.