体内外孕激素和GnRHa对子宫内膜异位症患者在位内膜血管内皮生长因子表达影响的差异

Effects of progestin and/or GnRHa on mRNA expression of VEGFs in eutopic endometrium with endometriosis

目的探讨孕激素和促性腺激素释放激素激动剂(GnRHa)对内异症患者在位内膜VEGFs表达的影响。方法子宫内膜细胞体外培养并行药物刺激,体内研究采集放置曼月乐,口服MPA或注射GnRHa后的患者内膜,以半定量RT-PCR方法检测内膜组织中VEGFs mRNA的表达。结果体外研究显示,孕酮和Gn-RHa均抑制内膜VEGFs mRNA的表达,病例组下降的幅度小于对照组。放置曼月乐和注射GnRHa均使在位内膜VEGFs mRNA表达明显升高,口服MPA组的VEGFs升高未达显著性差异。VEGFs mRNA的表达与MMP-9 mRNA呈正相关。结论孕激素和GnRHa体内用药对内异症患者在位内膜VEGFs表达的影响不能用体外干预的效应简单推论。VEGFs升高不一定引发突破性出血。

Objective To investigate the effects of progestin and/or GnRHa on the expression of VEGFs in eutopic endometrium of women with endometriosis. Methods we collected the samples of endometrium from patients with endometriosis before operation, after insertion of Mirena, oral - taken MPA or injection of GnRHa. Cultured endometrial cells were also incubated with progesterone or buserelin in vitro. The mRNA expression of VEGFs was determined by semi - quantitative RT - PCR. Results The mRNA expression of VEGFs was decreased significantly under progesterone （5 × 10 ^-5 mol/l） or buserelin （5 × 10^-9 g/ml） in vitro. The extent of reduction was less in patient group than control group. Following exposure to levenorgestrel or GnRHa in vivo, the mRNA expression of VEGFs was increased. The mRNA expression of VEGFs was positively related to the mRNA expression of MMP - 9. Conclusions The effects of progestins and/or GnRNa on eutopic endometrium were different in vitro and in vivo. The increment of VEGFs may not be sure to induce breakthrough bleeding.