PTEN、bcl-2/Bax表达预测子宫内膜增生孕激素治疗反应的研究

The predicting effect of expression of PTEN,bcl-2/ Bax in endometrial hyperplasia with progestine therapy

目的:研究孕激素治疗前后子宫内膜增生组织中PTEN基因、bcl-2/Bax的表达,结合临床治疗效果探讨其在预测孕激素治疗反应中的作用。方法:回顾分析子宫内膜增生患者56例(复杂性增生31例,非典型性增生25例),孕激素治疗3个月,留取治疗前后子宫内膜组织,取石蜡切片进行免疫组化染色,应用H-score评价孕激素治疗前后子宫内膜腺体中PTEN、bcl-2/Bax的表达。结果:(1)56例患者治疗3个月后,44例(78.57%)缓解,7例(12.50%)有效,1例(1.79%)治疗后复发,4例(7.14%)治疗无效,平均随访(33.49±9.62)个月。复杂性增生、轻度非典型性增生和中重度非典型性增生3组缓解+有效率的差异无统计学意义(P=0.245)。(2)子宫内膜增生组织中PTEN基因表达缺失率为16.07%(9/56),PTEN表达阳性组缓解+有效率为97.87%(46/47),PTEN表达阴性组缓解+有效率为55.56%(5/9),两组间比较差异有统计学意义(P<0.05)。(3)56例患者孕激素治疗前后子宫内膜腺体中bcl-2及Bax表达均阳性。缓解和有效组与复发和无效组治疗前bcl-2/Bax的H-score值无明显差异(P=0.486),两组治疗前后H-score差值亦无明显差异(P=0.368)。结论:子宫内膜增生组织中PTEN基因表达阳性组对孕激素治疗反应较好,PTEN基因表达缺失可能提示病变对孕激素抵抗,因此治疗前检测子宫内膜腺体细胞中PTEN基因的表达可以预测疗效;bcl-2/Bax不能作为预测孕激素治疗反应的指标。

Objective：To study the expression of PTEN,bcl-2/Bax in endometrial hyperplasia with progestine therapy,and explore its predicting effect of progestine therapy.Methods：The clinical and pathological characteristics of 56 patients diagnosed with endometrial hyperplasia（31 of complex hyperplasia and 25 of atypical hyperplasia）were studied respectively.The expressions of PTEN,bcl-2 and Bax in endometrial glands of paraffin-embedded endometrial hyperplasia specimens were evaluated by immunohistochemistry technique.Results：（1）Among 56 cases,44 cases（78.57%）were resoluted,7 cases（12.50%）were regressed,1（1.79%）case was recurred and 4 cases（7.14%）were invalid.The follow-up average time was（33.49±9.62）months.Among complex hyperplasia,simple atypical hyperplasia and complex atypical hyperplasia,resolution and regression ratio had no difference（P=0.245）.（2）Before treatment,PTEN expression were negative in 9/56 cases（16.07%）.Resolution and regression ratio was 5/9（55.56%） in negative groups and 46/47（97.87%）in positive groups,with significant difference（P0.05）.（3）bcl-2 and Bax were positive in all samples.Both the H-score value before treatment and the different value of H-score before and after treatment had no difference between resoluted/regressed groups and recurred/invalid groups.Conclusions：The response to progestine in PTEN positive groups is better than negative groups.PTEN-loss might indicate resisting to progestin.Detecting PTEN in endometrial glands before treatment might predict effect of progestin.bcl-2/Bax would not be a predictor of response to progestin therapy.