左炔诺孕酮宫内缓释系统对增生过长子宫内膜IGF-I和IGF-II及其相应受体表达的影响

Influence of the levonorgestrel-releasing intrauterine system on the insulin-like growth factors and their receptors of endometria hyperplasia

目的:探讨左炔诺孕酮宫内缓释系统对增生过长子宫内膜IGF-I和IGF-II及其相应受体表达的影响。方法:应用免疫组化链霉亲和素-生物素-过氧化物酶复合物方法检测20例子宫内膜增生过长患者宫内置入左炔诺孕酮宫内缓释系统前及置入3个月后子宫内膜IGF-I和IGF-II及其相应受体的表达,并设子宫内膜增生过长口服炔诺酮治疗3个月后患者子宫内膜对照组。结果:(1)宫内置入左炔诺孕酮宫内缓释系统3个月后,IGF-I表达下降,IGF-II的表达上升,与治疗前比较有显著性差异(P<0.05)。左炔诺孕酮宫内缓释系统治疗组子宫内膜IGF-I表达下降比炔诺酮治疗组明显,两者比较有显著性差异(P<0.05),IGF-II在左炔诺孕酮宫内缓释系统治疗后的子宫内膜的表达高于炔诺酮治疗后的子宫内膜,但统计学检验差异无显著性。(2)左炔诺孕酮宫内缓释系统治疗前后IGF-IR表达无显著性变化,P>0.05;炔诺酮对照组与左炔诺孕酮宫内缓释系统治疗后子宫内膜IGF-IR表达的比较亦无差异(P>0.05)。(3)宫内置入左炔诺孕酮宫内缓释系统3个月后,IGF-IIR表达增强,治疗前后比较有显著性差异(P<0.05);左炔诺孕酮宫内缓释系统治疗后子宫内膜IGF-IIR表达增加较炔诺酮治疗后的子宫内膜明显,两者差异有显著性(P<0.05)。结论:左炔诺孕酮宫内缓释系统通过抑制增生过长的子宫内膜IGF-I表达,上调IGF-II的表达,抑制雌激素对子宫内膜的增生效应并使子宫内膜发生蜕膜样变,是左炔诺孕酮宫内缓释系统治疗子宫内膜增生过长的重要机制。局部和血液循环孕激素浓度变化对IGF-IR表达无显著影响。宫内放置左炔诺孕酮宫内缓释系统对子宫内膜IGF系统的调节作用较口服炔诺酮显著。

Objective To study the influence of the levonorgestrel-releasing intrauterine system on the insulin-like growth factors and their receptors of endometria hyperplasia. Methods The expression of the IGF-Ⅰ, IGF-Ⅱ and their receptors in the hyperplasia endometria before and after carrying LNG-IUS and taking norethisterone for three months was detected by immunohistochemistry method. Results （1）The expression of IGF-Ⅰ was significantly down-regulated and IGF-Ⅱ up-regulated in LNG-exposed endometria when compared with the endometria before the treatment （P〈0. 05）. The expression of IGF-Ⅰ in the endometria treated by LNG-IUS was significantly lower than the endomertria treated with northisterene （P〈0. 05）. The expression of IGF-Ⅱ was higher in the endometria treated with LNG-IUS than in the endometria treated by northisterene though the statistics analysis was not significantly different（P〉0.05）. （2）The expression of IGF-IR didn＇t show any noteworthy difference between before and after LNG-exposed and northisterone-exposed （P〉0.05）. （3）After treated with LNG-IUS for 3 months,the expression of IGF-IIR was increased in the endometrial tissue level（P〈0.05） and it was higher than the northisterone control group （P〈0. 05 ）. Conclusion Strong expression of IGF-Ⅱ, with suppression of IGF-Ⅰ in endometria exposed to LNG, suggests that this may be the mechanism of this device to inhibit endometria hyperplasia and reverse of endometria and LNG-IUS had stronger influence on the IGFs of endometria than northisterone.