子宫内膜异位症患者血浆及组织中骨桥蛋白表达及其作用机制的研究

Expression of osteopontin in plasma and tissue in endometriosis and its mechanisms

目的:检测子宫内膜异位症(endometriosis,EM)组织中骨桥蛋白(osteopon-tin,OPN)、血管内皮生长因子(vascular endothelial growth factor,VEGF)的表达,探讨子宫内膜异位症的发病机制,OPN在子宫内膜异位症血浆中的含量以及OPN在子宫内膜异位症诊断及鉴别诊断方面的应用。方法:用免疫组化SP法检测56例子宫内膜异位症患者异位内膜及在位内膜中OPN、VEGF的表达,用酶联免疫吸附方法检测患者术前血浆OPN含量。结果:(1)异位内膜OPN表达主要分布于腺上皮细胞细胞膜,阳性(++^+++)表达率与在位内膜相似,明显高于对照内膜,差异有显著性(P<0.01),异位内膜细胞大多受挤压萎缩,缺乏典型的周期性改变;(2)VEGF在异位内膜胞浆染色,呈棕色颗粒,表达阳性,其中阳性(++^+++)表达率明显高于在位内膜及对照内膜(P<0.01);(3)异位内膜组织中OPN、VEGF表达有相关性(rs=0.596,P<0.01)。在子宫肌瘤对照内膜组织OPN、VEGF的表达则无相关性(rs=0.153,P=0.507);(4)子宫内膜异位症患者术前血浆OPN均值46.26±8.72ng/m l(15.54~139.12ng/m l),高于良性肿瘤及正常对照组(P<0.01),后二者无显著差异。卵巢癌患者术前血浆OPN均值81.32±14.41ng/m l(22.72~197.94ng/ml),较内异症患者水平高(P<0.01)。结论:OPN在异位内膜细胞高表达,可能推动异位内膜黏附和侵袭,OPN、VEGF可能通过促血管生成,共同促进异位内膜种植与生长,在子宫内膜异位症发生发展中起重要作用;OPN在盆腔包块鉴别诊断方面有一定应用价值。

Objective：To investigate the expression of osteopontin（OPN） and vascular endothelial growth factor（VEGF） in tissues of endometriosis as well as its function and the clinical value of osteopontin in plasma of endometriosis. Methods：The expression of OPN and VEGF in tissue of endometriosis was measured by immunohistochemistry. The pre-operational level of plasma OPN was measured by enzyme-linked immunosobent assay in 56 cases of endometriosis. Results： （ 1 ） OPN was expressed in the gland epithelium cells. The expressions of OPN in ectopic endometrium and eutopic endometrium of endometriosis were higher than that of eutopic endometrium of myoma. There was no change of ectopic endometrium from proliferative to secretory stage ; （2） VEGF was expressed in the cytoplasm of ectopic endometrium cells. The expression of VEGF in endometriosis lesion were higher than that of eutopic endometrium of endometriosis and myoma ; （3） The expression of OPN in ectopic endometrium was closely related to that of VEGF, but there were no relation between OPN and VEGF in eutopic endometrium of myoma; （4）The pre-operational level of plasma OPN was significantly higher（46.26±8.72ng/ ml） in 56 patients with endometriosis than that of benign ovarian tumor and healthy controls （ P 〈0.01）.The level of plasma OPN in epithelial ovarian cancer （81.32 ±14.41ng/ml） was much higher compared with endometriosis patients （ P 〈 0.01 ）. Conclusions： OPN is overex- pressed in ectopic endometrium, which suggests that OPN may be correlated with adherence and aggression in endometriosis. It provides evidence for the cooperative roles of OPN and VEGF in angiogenesis, which can promote the evolvement of endometriosis. The level of plasma OPN may be useful in differential diagnosis of pelvic cyst.