芳香化酶蛋白及性激素受体等在子宫内膜病变组织中的表达变化及意义

Expressions of aromatase protein and sex hormone receptor in endometrial lesions

目的探讨芳香化酶蛋白、雌激素受体(ER)、孕激素受体(PR)及细胞增殖相关核抗原Ki67在子宫内膜病变组织中的阳性表达率及其在子宫内膜病变的诊断和治疗中的价值。方法采用免疫组化链霉菌抗生物素蛋白-过氧化物酶链接(SP)法,检测148例子宫内膜病变患者(观察组,其中子宫内膜增殖症30例,轻、中、重度子宫内膜非典型增生各10例,子宫内膜腺癌88例)及30例因患宫颈原位癌行子宫全切除术患者的正常子宫内膜组织(对照组,其中增殖期及分泌期子宫内膜各15例)中芳香化酶蛋白、ER、PR及Ki67的阳性表达率。结果(1)观察组子宫内膜增殖症、子宫内膜非典型增生组织芳香化酶蛋白、ER、PR、Ki67的阳性表达率与对照组增殖期内膜比较,差异无统计学意义(P>0·05);(2)观察组子宫内膜腺癌组织芳香化酶蛋白阳性表达率为64%(56/88),与子宫内膜非典型增生(23%,7/30)、子宫内膜增殖症(13%,4/30)及对照组(0/15)比较,差异均有统计学意义(P<0·01);(3)芳香化酶蛋白的阳性表达率与子宫内膜腺癌的临床分期(Ⅰ期61%、Ⅱ期77%、Ⅲ期70%、Ⅳ期67%)、肿瘤细胞分化级别(高分化64%,中分化74%,低分化58%)、有无淋巴转移(转移59%,无转移67%)无明显相关性(P>0·05)。(4)子宫内膜腺癌组织中ER、PR、Ki67的阳性表达率分别为22%(19/88)、19%(17/88)、41%(36/88),与对照组分别比较,差异均有统计学意义(P<0·01)。结论子宫内膜良性病变组织与正常内膜组织中,芳香化酶蛋白表达无明显差异;子宫内膜腺癌组织中芳香化酶蛋白的过度表达,可作为诊断子宫内膜腺癌的指标之一。

Objective To investigate the expression of aromatase protein, estrogen receptor （ER）, progesterone receptor （ PR ） and nuclear antigen associated with cell proliferation Ki67 in endometrial diseases and their clinical significance in diagnosis and endocrine therapy of endometrial diseases. Method Expressions of aromatase, ER, PR and Ki-67 were detected with immunohistochemistry technic（ streptavidinperoxidase-biotin, SP） in 148 cases including 30 of endometrial hyperplasia, 30 of atypical proliferation and 88 of endometrial adenocarcinoma as observational group and 15 cases of proliferative endometrium and 15 cases of secretory endometrium as control group. Results Expression of aromatase protein and ER, PR, Ki67 in endometrial hyperplasia, atypical proliferation had no significant difference comparing with the proliferative endometrium group （ P 〉 0. 05 ）. In endometrial adenocarcinoma, the expression of aromatase protein increased obviously（64% ,56/88） ,which was higher than in benign diseases [ atypical proliferation group was 23% （7/30）, endometrial hyperplasia group was 13% （4/30） ] and control group significantly （P 〈0. 01 ）. The positive expression of ER, PR in endometrial adenocareinoma decreased [ 22% （19/88）, 19% （17/88）], and Ki67 increased （41%, 36/88） and there was a significant difference compared with control group （ P 〈 0. 01 ）. The positive rate of aromatase protein did not increase with the progress of clinical stage or grade of cellular differentiation. Aromatase was not consistent with ER, PR and Ki67 in endometrial adenocareinoma. Condusion Aromatase protein is related to the incidence of endometrial adenocareinoma, and the expression of proteins （ aromatase, ER, PR and Ki67 ） provides theoretical basis for understanding biological behavior of endometrial adenocareinoma.