左炔诺孕酮宫内缓释系统对增生过长子宫内膜的雌孕激素受体的影响

Effects of levonorgestrel-releasing intrauterine system on endometrial estrogen and progesterone receptors in patients with endometrial hyperplasia

目的用形态计量学方法分析左炔诺孕酮宫内缓释系统(LNG-IUS)放置前后增生过长子宫内膜局部雌孕激素受体变化,以探讨LNG-IUS治疗子宫内膜增生过长患者的有效性。方法观察25例无排卵型功血患者增生过长子宫内膜LNG-IUS放置前后子宫内膜组织学变化,用免疫组化法测定雌激素受体(ER)、孕激素受体(PR)含量变化。结果 LNG-IUS放置后6个月子宫内膜增殖受到明显抑制,表现为子宫内膜腺体数目明显减少,腺体发育不良,间质细胞有明显的蜕膜样变。治疗前大部分腺体上皮和间质细胞ER、PR免疫着色显示为强染。治疗后子宫内膜雌孕激素受体表达下降,腺上皮细胞和间质细胞中ER、PR阳性细胞数均明显减少。结论 LNG-IUS可抑制子宫内膜增殖,降低雌孕激素受体表达,对于治疗简单型和复杂型子宫内膜增生过长的患者是有效的。

Objective To investigate the changes in local endometrial contents of estrogen receptors （ER） and progesterone receptors （PR） after insertion of levonorgestrel-releasing intrauterine system （LNG-IUS） and evaluate the efficacy of LNG-IUS in treating endometrial hyperplasia. Methods The endometrial histological changes were observed in 25 anovulatory women with dysfunctional uterine bleeding after insertion of LNG-IUS, and the contents of ERs and PRs in the endometerium were measured by immunohistochemistry. Results The endometrial proliferation activity was obviously inhibited 6 months after LNG-IUS insertion with decreased endometrial glands, glandular dysplasia and dedualization of interstitial cells. The positive cell rate for ERs and PRs in the glandular epithelial and interstitial cells were significantly reduced after LNG-IUS insertion. Conclusions LNG-IUS can reduce ER and PR expressions in the endometrium and inhibit endometrial proliferation, and therefore can be effective in treating simple and complex endometrial hyperplasia.