子宫内膜异位症性不孕症与MMP-2及性激素的关系

THE RELATIONSHIP INFERTILITY DISEASES OF ENDOMETRIOSIS AND MATRIX METALLOPROTEINASE-2 AND SEX HORMONE

目的 :探讨子宫内膜异位症尤其是子宫内膜异位症性不孕症患者的外周血和腹腔液中MMP - 2和性激素的浓度变化及在内异症性不孕症中所起的作用。方法 :采用ELISA和RIA方法测定了 4 7例子宫内膜异位症性不孕症患者和 18例非子宫内膜异位症患者外周血和腹腔液中MMP - 2和E2、P浓度。将内异症分为轻度 (Ⅰ、Ⅱ期 )组和重度组 (Ⅲ、Ⅳ期 ) ,非内异症患者为对照组。结果 :外周血中轻度和重度内异症患者MMP- 2和E2高于对照组 ,而且增殖期高于分泌期 (P <0 .0 5 ) ,但轻度内异症组与重度组比较无显著性差异 (P >0 .0 5 )。轻度和重度内异症组相比 ,重度组E2高于轻度组 (P <0 .0 5 ) ;P在内异症组和对照组间无差异显著性 (P >0 .0 5 ) ;在腹腔液中 ,轻度和重度内异症组MMP - 2均高于对照组 (P <0 .0 5 ) ,腹腔液中MMP - 2及E2均明显高于外周血 ;MMP - 2和E2在增殖期高于分泌期 ,P在分泌期高于增殖期 ,轻度EMS组及重度EMS组和对照组间无差异显著性 (P >0 .0 5 ) ,但轻度EMS组P低于重度EMS组。E2和MMP - 2呈正相关 ,P和MMP - 2呈负相关。结论 :MMP - 2和E2、P参与了子宫内膜异位症的形成和发展 ,改变了生殖内环境 ,导致了轻度内异症性不孕。抑制MMP在盆腔内的含量 ,改善生殖内环境可提高内异症性不孕症的治愈率。

Objective:To study concentration variation and function of matrix metalloproteinase-2 (MMP-2) and estradiol (E2) and progesterone (P) of serum and peritoneal fluid of women with endometriosis and infertility of endometriosis.Methods: 47 cases with infertility of endometriosis diagnosed by iaparoscopic surgery were divided into two groups: 31 cases in mild group ( Ⅰ?Ⅱ stage) and 16 cases in severe group (Ⅲ? Ⅳ stage). 18 women with normal pelvic cavity were used as control. MMP-2,E2 and P were determined by ELISA and RIA.Result:The concentration of MMP-2 and E2 of sera and peritoneal fluid of endometriosis groups were higher than that of control group.The level in follicular phase were higher than that in the tuteal phase ( P <0.05).The concentration of MMP-2 and E2 in peritoneal ftuid were remarkabty higher than that in sera ( P <0.01). The level of the two groups of endometriosis weren't differenct ( P >0. 05), But the concentration of E2 of severe endometriosis group was higher than that of mild one ( P <O.05) The concentrations of P in follicularphage of both endometriosis groups and control group weren't differenct( P >0.05). The concentration of P of serum and peritoneal fluid in the luteal phase of control were higher than that ofendometriosis group ( P >0.05 ).The MMP-2 concentration in serum and peritoneal fluid . were significantly correlated with E2 concentrations(r=0.679 and 0.678, P =0.000 and 0.000 respectivety), and was negatively correlated with P concentration( r=-0513 and -0.757, P =0.029 and 0.004, respectively).Conclusions:MMP-2? E2 and P participate in the forming and developing of endometriosis. To reduce the level of MMP-2 in pelvic cavity and improve inner environment of reproduction may have action for increasing cure rate of infertility of endometriosis.