子宫内膜异位症相关慢性盆腔痛患者子宫在位内膜PGP9.5表达的临床意义

Clinical Significance of Expression of PGP 9.5 in Eutopic Endometrium of Patients with Endometriosis-Related Chronic Pelvic Pain

目的研究蛋白基因产物9.5(protein gene product 9.5,PGP 9.5)在子宫内膜异位症(endometriosis,EMs)患者在位内膜功能层的表达及其与慢性盆腔痛(chronic pelvic pain,CPP)的关系,探讨神经纤维(PGP 95的表达)在EMs相关CPP中的作用以及GnRHa药物对其治疗效果。方法对40例行手术治疗的EMs患者(EMs组)和40例同期手术的育龄期妇女(对照组)采用免疫组织化学SP法,检测子宫在位内膜功能层中PGP 9.5的表达。通过视觉模拟评分法(VAS)对EMs患者进行CPP程度及手术分期(rAFS)评定,并采用Spearman法分析两者与PGP 9.5的相关性。对EMs患者促性腺激素释放激素激动剂(GnRHa)治疗前后在位内膜PGP 9.5表达情况进行比较。结果 EMs组子宫在位内膜功能层的PGP 9.5表达为10.48±4.44,对照组未见PGP 9.5表达(P<0.01)。Spearman相关性分析:EMs患者子宫在位内膜功能层PGP 9.5表达与CPP的VAS评分呈正相关(r=0.833,P<0.01),与rAFS无相关性(r=-0.094,P>0.05)。EMs患者术后使用GnRHa治疗后PGP 9.5表达及VAS评分显著低于治疗前(P<0.01)。结论 EMs CPP患者在位内膜功能层中PGP 9.5的特异性表达,可能为EMs早期诊断提供新的生物标识物;EMs子宫在位内膜功能层PGP 9.5的高表达与CPP呈正相关,与rAFS无相关。GnRHa类药物缓解EMs CPP的原因之一是减少了EMs在位内膜中神经纤维分布密度。

Objective To study the expression of protein gene product 9. S （PGP 9. 5） in the functional layer of eutopic endometrium and its relation to chronic pelvic pain（CPP） in patients with endometriosis（EMs）, and to investigate the role of PGP 9.5 expression and the curative efficacy of gonadotrophin-releasing hormone agonist（GnRHa） in EMs-related CPP. Methods The expression of PGP 9.5 in the functional layer of eutopic endometrium was detected by immunohis- toehemistry in 40 patients treated with surgery for EMs（EMs group） and 40 women of childbearing age（control group）. The degree of CPP and stage of endometriosis were evaluated by using visual analogue scale（VAS） and revised American Fertility Society（rAFS） classification system, respectively. The correlations of VAS and rAFS scores with PGP 9.5 expression were analyzed by using Spearman method. In addition, the expression of PGP 9.5 was detected in EMs patients before and after treatment with GnRHa. Results The expression of PGP 9.5 in the functional layer of eutopic endometrium was 10. 48±4. 44 in EMs group. No PGP 9.5 expression was found in control group. In patients with EMs-related CPP, PGP 9.5 expression was positively correlated with VAS score（r=0. 833, P〈0.01）, but was not correlated with rAFS score（r=-0. 094, P〉 0.05）. After operation, the treatment with GnRHa significantly reduced PGP 9.5 expression and VAS score in patients with EMs（P〈0.01）. Conclusion The PGP 9.5 is expressed specifically in the functional layer of eutopic endometrium, suggesting that PGP 9.5 may be a new biomarker for early diagnosis of EMs. The high expression of PGP 9.5 in eutopic endometrium is positively correlated with CPP,but is not correlated with rAFS in EMs patients. The GnRHa can relieve the EMs-related CPP through reducing the density of endometrial nerve fibers.