子宫内膜异位症患者内膜雌、孕激素受体测定及口服棉酚后的变化

Estrogen and progesterone cytosol receptor con-centrations in patients with endometriosis andtheir changes after gossypol therapy

采用葡聚糖活性碳吸附法，对２７例正常生育妇女（对照组）及２４例子宫内膜异位症患者（Ｅｍ组），测定了宫腔内膜雌激素胞浆受体（ＥＲｃ）、孕激素胞浆受体（ＰＲｃ）浓度。并测定Ｅｍ组中１５例口服醋酸棉酚２个月后，月经周期同日测定ＥＲｃ及ＰＲｃ浓度；同时对１６例手术切除的子宫、附件标本的原位内膜与异位内膜的ＥＲｃ、ＰＲｃ浓度进行比较。结果：对照组子宫内膜ＥＲｃ、ＰＲｃ浓度呈周期性变化，以卵泡晚期最高，黄体中期显著下降（Ｐ＜０．０５），黄体晚期进一步降低。Ｅｍ组原位内膜ＥＲｃ、ＰＲｃ浓度及周期性波动与对照组无差异，但异位内膜ＥＲｃ、ＰＲｃ浓度显著低于原位内膜（Ｐ各＝０．００３６及＜０．０００１），且失去周期性变化。口服棉酚２个月后血清雌二醇、孕酮浓度无显著下降，４例（２６．７％）患者子宫内膜组织相显示腺体分泌减少，但原位内膜ＥＲｃ、ＰＲｃ浓度却已显著降低（Ｐ＝０．０２１７及０．０１）。本研究提示：异位内膜与原位内膜对内源性性激素反应的不同步现象与异位内膜雌、孕激素受体浓度低下有关；棉酚对原位内膜ＥＲｃ、ＰＲｃ浓度的早期抑制现象，并不依赖于对卵巢功能的抑制作用，这一作用途径应对异位内膜同样有效。

strogen and progesterone cytosol receptor (ERc,PRc) concentrations of cndometrium biopsied duringdifferent phases of menstrual cycle were measured bydextran-coated charcoal method in 27 normal fertilewomen and 24 patients with endometriosis.15 out of24 endometriotic patients were put on gossypol for 2months thereafter.After discontinuation of the drug,ERc,PRc contents of endometrium were reexaminedduring the same cycle day.serum estradiol (E2) andprogestcrone (P) levels were also compared before andafter gossypol treatment.In addition,endometriotictissue and intrauterine endometrium were immediatelyobtained from the same patient after surgery in 16cases with endometriosis.and their ERc,PRc concen-trations were also compared. Results: endometrium ERc,PRc concentrationsofnormal controls fluctuated during the menstrual cy-cle,with the peak at late follicular phase. Inendometriosis group、the ERc,PRc contents andcyclic changes of endometrium in situ were notsignificantly different from the nonnal controls.How-ever,the ERc,PRc contents of cndometriotic tissuewere significantly lower than those of endometrium insitu(P=0.0036 and<0.0001 respectively)withoutcyclic changes during menstrual cycle,After 2 monthsof gossypol therapy.serum E2 and P levels tended todecrease but the differenees were not significant.Glandular secretion of endometrium decreased in only4 out of 15 cases under pathological examination. Incontrast,the ERc. PRc concentrations ofendometrium in situ differed significantly from thepretreatment values(P=0.0217 and 0.01 respectively). These data indicated:(1) The response ofendometriotic tissue to estrogen and progestin waslower than that of endometrium in situ. (2) Gossypolhasa direct inhibitory effect on endometrium, alsoendomel riotic tissue,possibly through sex steroidreeeptor mechanism.