症状性子宫肌瘤子宫内膜中PGI_2、TXA_2、NOS的表达

Expression levels of PGI_2, TXA_2 and NOS in the endometrium of patients with symptomatic uterine leiomyomas

目的:了解症状性子宫肌瘤患者子宫内膜PGI、TXA2、NOS的表达水平。方法:子宫肌瘤患者子宫内膜标本70例,根据临床有无异常子宫出血的症状分为A组和B组,A组(症状性子宫肌瘤)45例,其中增生期15例,分泌期13例,单纯增生过长10例,复杂增生过长7例;B组(无症状性子宫肌瘤)25例,其中增生期12例,分泌期13例。对照组分为C组和D组,C组正常子宫内膜组28例,其中增生期15例,分泌期13例;D组功能失调性子宫出血30例,其中增生期11例,分泌期8例,单纯增生过长8例,复杂增生过长3例。采用免疫组化法检测各组子宫内膜中的NOS的表达水平,采用放射免疫法测定各组PGI2和TXB2稳定的代谢产物6-keto-PGFla和TXB2的表达水平。结果:A组子宫内膜6-keto-PGFla、TXB2、iN-OS、eNOS的表达水平分别与B组和C组比较,6-keto-PGFla、iNOS、eNOS表达水平均升高(P值均<0.001),TXB2水平较B组降低,有统计学差异(P<0.001)、与C组比较水平降低,但差异无统计学意义(P>0.05);而A组子宫内膜6-keto-PGFla、TXB2、iNOS、eNOS的表达与D组比较,均无统计学差异(P>0.05)。B组与C组子宫内膜6-keto-PGFla、TXB2、iN-OS、eNOS的表达水平比较,差异均无统计学意义(P>0.05)。D组分别与B组和C组比较,6-keto-PGFla、iNOS、eNOS表达水平升高,有统计学差异(P值均<0.001),TXB2水平降低,有统计学差异(P值均<0.001)。结论:症状性子宫肌瘤患者子宫内膜中存在PGI2、TXA2、NOS的表达异常,且这种异常变化趋势与功能性子宫出血的内膜变化趋势一致。症状性子宫肌瘤患者子宫内膜中PGI2、TXA2、NOS的表达异常是临床上发生异常子宫出血的原因,子宫肌瘤和功血可以并存。

Objective： To understand the expression levels of PGI2 , TXA2 and NOS in the endometrium of patients with symptomatic uterine leiomyomas. Methods： 70 patients with uterine leiomyomas were divided into group A and group B based on the symptom of menorrhagia and then divided further into different subgroups based on morphological examination of endometriums. 45 patients with symptom- atic uterine leiomyomas in group A consisted of 15 patients with proliferative phase endometrium, 13 patients with secretory phase endometriurn, 10 patients with simple hyperplasia endometrium and 7 patients with complex hyperplasia endometrium. 25 patients with asymptomatie uterine leiomyomas in group B consisted of 12 patients with the proliferative phase endometrium and 13 patients with secretory phase endometrium. 28 healthy women in group C consisted of 15 patients with proliferative phase endometrium and 13 patients with secretory phase endometrium. 30 patients with dysfunctional uterine bleeding in group D consisted of 11 patients with proliferative phase endometrium, 8 patients with secretory phase endometrium, 8 patients with simple hyperplasia endometrium and 3 patients with complex hyperplasia endometrium. Immunohistochemistry was used to detect the level of NOS, and the levels of PGI：, 6 - keto - PGFla and TXB2 were determined by radioimmunoassay. Results： The levels of 6 - keto - PGFla, iNOS and eNOS in endometrium in group A were higher than those in group B and group C （P 〈0. 001 ）, while the level of TXB2 reversed （P 〈 0. 001 ）; there was no significant difference in the level of TXB2 between group A and group C （P 〉 0. 05 ） ; there was no significant difference in the levels of 6 - keto - PGFla, TXB2, iNOS and eNOS in endometrium between group A and group D （P 〉 0. 05 ） . There was no significant difference in the levels of 6 -keto -PGFla, TXB2, iNOS and eNOS in endometrium between group B and group C （P 〉 0. 05 ） . The levels of 6 - keto - PGFla, iNOS and eNOS in endometrium in group D were higher than those in group B and group C （P 〈 0. 001 ）, while the level of TXB2 reversed （P 〈 0. 001 ） . Conclusion ： Abnormal expression levels of PGI2 , TXA2 and NOS in endometrium of patients with symptomatic uterine leiomyomas are related to the change tendency of endometrium of dysfunction uterine bleeding, which are responsible for menorrhagia of patients with uterine leiomyomas. Leiomyomas of uterine and dysfunction uterine bleeding can exist at the same time.