曼月乐治疗子宫内膜增生症的疗效观察及机制探讨

The observation of therapeutic effeet and mechanism of Mirena for endometrial hyperplasia

目的:观察曼月乐治疗子宫内膜增生症的临床效果,并对其作用机制进行探讨。方法:观察40例诊断为子宫内膜增生症的患者放置曼月乐前及放置后3个月、6个月、12个月月经量变化。放置前和放置后12个月分别行宫腔镜检查,采用免疫组化半定量法测定子宫内膜雌、孕激素受体(ER、PR)、Ki-67与Bcl-2、Bax表达情况。结果:放置曼月乐前月经PBAC评分为210.1±44.96,放置后第3个月、第6个月及第12个月月经PBAC评分分别为51.08±12.03、21.83±10.06及8.25±2.99,差异有统计学意义(P<0.01)。放置曼月乐12个月后,宫腔镜图像显示子宫内膜变得菲薄,子宫内膜病理示子宫内膜增生过长改变消失,内膜呈分泌现象及间质蜕膜样变。放环后12个月ER、PR和Ki-67的表达显著降低,Bcl-2在腺体细胞中表达亦下降,Bax表达明显升高(P<0.01)。结论:曼月乐能有效减少子宫内膜增生症患者的月经量,其作用机制可能通过抑制ER、PR、Ki-67、Bcl-2的表达,增加Bax的表达,诱导子宫内膜细胞凋亡,从而使增生的子宫内膜发生逆转。

Objective： To observe the clinical effect of Mirena in the treatment of endometrial hyperplasia and to explore its mechanism. Methods： Menstrual flow volumes was observed in 40 patients who were diagnosed as endometrial hyperplasia before and after three, six and twelve months Mirena inserted. Hysteroscopy was carried out before and 12 months after Mirena inserted. The expression of the estrogen receptor （ER）, progesterone receptor （PR）, Ki-67, Bcl-2 and Bax was investigated with immunohistochemistry. Results： The PBAC score of menstrual flow was respectively 210.1 ± 44.96, 51.08 ± 12.03, 21.83 ± 10.06 and 8.25 ± 2.99 before and after three, six and twelve months Mirena inserted,the difference was significant （P〈0.01）. After 12 months of Mirena inserted in the uterus,endometrium meager was discovered in hysteroscopy. Endometrial pathology showed that endometrial hyperplasia was all disappeared, intima secretion phenomenon and stromal decidualization. After Mirena inserted, expression of ER, PR and Ki-67 was significantly lower, expression of Bcl-2 in endometrial glands also decreased, Bax expression was elevated （P〈0.01）. Conclusion： Mirena is effective in reducing menstrual flow. Its mechanism may be inhibiting ER, PR, Ki-67, Bcl-2 expression, increasing expression of Bax, inducing endometrial apoptosis and proliferation of endometrial reversed.