不明原因不孕症患者黄体中期子宫内膜E-钙黏素的表达及其与性激素关系的研究

Expression of E-cadherin in Endometrium of Patients with Unexplained Infertility during Luteal Metaphase and the Relationship between E-cadherin and Sex Hormone

目的:探讨不明原因不孕患者黄体中期E-钙黏素在子宫内膜中的表达与同期血清性激素的相关性。方法:选择不明原因不孕患者45例,随机分为研究组30例(A组)、对照组15例(B组),另选正常生育妇女17例为正常对照组(C组)。A组排卵后第2日起注射黄体酮7d,用药2个周期,B、C组不作治疗。用免疫组化法检测A组治疗前后及B组、C组黄体中期子宫内膜E-钙黏素的表达;用放射免疫法检测3组同期血清E2、P4水平。结果:A、B组黄体中期E-钙黏素的表达及同期血清E2、P4、P4/E2均明显低于C组(P<0.01);E-钙黏素的表达与P4和E2均呈正相关,与P4/E2无相关性;A组治疗后E-钙黏素、P4和P4/E2均高于治疗前(P<0.01);A组治疗后妊娠率高于B组;当P4>40nmol/L妊娠率最高,且妊娠率随P4/E2增高而提高。结论:不明原因不孕患者黄体中期E-钙黏素表达缺陷、P4不足、P4/E2比例失调是影响子宫内膜容受性的重要原因。孕激素干预治疗对E-钙黏素的表达有调节作用。

Objective：To explore the relationship between E-cadherin and serum levels of sex hormone in endometrium of patients with unexplained infertility during luteal metaphase.Methods：Forty-five cases with unexplained infertility were selected and divided into 2 groups,30 cases in group A（study group）,15 cases in group B（control group）,and 17 healthy women with normal fertility were included in group C（normal control group）.The patients in group A were given progesterone injection about 7 d after the second day of their ovulation,then,two cycles later we gave them a review.The expression of E-cadherin with all subjects in endometrium during luteal metaphase was detected by immunohistochemistry methed,and the serum levels of E2,P were detected by radioimmunoassay.Results：The levels of E-cadherin and the serum levels of E2,P4,P4/E2 in each group of the patients during luteal metaphase were obviously lower than those in group C,P〈0.01.After treatment,the levels of E-cadherin,P4,P4/E2 during luteal metaphase in group A,were higher than those pre-treatment,P〈0.01.There was a positive relation between the levels of E-cadherin and serum P4,E2,but no relation was found between P4/E2 and the level of E-cadherin.The gestation rates in group A was higher than that in group B.The gestation rate of P4〉40 nmol/L was obviously higher than that of P4〈40 nmol/L.The higher of P4/E2 was,the higher of the gestation rate was.Conclusion：In patients with unexplained infertility,the defect of E-cadherin＇s expression,the deficiency of P4 and mal-proportion of P4/E2 are the main reasons which can influence the endurement of endometrium during luteal metaphase.The intervention treatment of progesterone can adjust the expression of E-cadherin.