左炔诺孕酮宫内释放系统对子宫内膜息肉术后ER、PR的影响研究

Study of effect of levonorgestrel intrauterine system on ER and PR with endometrial polyps

目的观察子宫内膜息肉术后放置左炔诺孕酮宫内释放系统对子宫内膜组织的雌激素受体（ER）、孕激素受体（PR）的影响,探讨子宫内膜息肉复发的可能存在机制。方法选取2010年1月31日~2012年1月31日期间在我院行宫腔镜下子宫内膜息肉切除术患者175例进行随机分组,82例研究组术后子宫内即时放置左炔诺孕酮宫内释放系统,而93例对照组不放置。分别对术中内膜组织及术后6个月子宫内膜活检通过免疫组化法对雌激素受体、孕激素受体的表达情况进行对比,且追踪随访2年,了解患者子宫内膜息肉复发情况。结果所有患者均手术成功。研究组内膜组织ER、PR表达术后明显低于术中,差异有统计学意义（P〈0.05）,对照组ER、PR的表达差异无统计学意义（P〉0.05）。随访2年对照组86例患者中8例子宫内膜息肉复发,而研究组无复发,差异有统计学意义（P〈0.05）。结论左炔诺孕酮宫内释放系统可能通过抑制子宫内膜的ER、PR来降低子宫内膜息肉复发。

Objective To observe the effect of levonorgestrel intrauterine system on esterone receptor（ER） and progesterone receptor（PR） in endometrial tissue after endometrial polyps, then understand the proper pathogenesis of ER and PR in endometrial polyps. Methods A total of 175 consecutive cases of patients with endometrial polyps were analyzed from January 31th,2010 to January 31th, 2012 in our hospital. 82 cases patients with endometrial polyps were served as test group with levonorgestrel Intrauterine system in uterus after hysteroscopic electroresection, and the other 93 cases were treated as control group who with no levonorgestrel intrauterine system application. The ER and PR expression of endometrial biopsy specimens during intraoperative and rechected after 6 months were measurd by immunohistochemistry. Patients were followed up for 2 years to analyze endometrial polyp recurrence. Results All patients had been received successful surgery. Intraoperative specimens were compared with afteroperation specimens of the ER and PR expression, there was a significant differences in study group（P〈0.05）, but control group（P〈0.05）. Followed up for 2 years, the endometrial polyp recurrence was 8 cases in control group and no one in study group,there was significant differences（P〈0.05）. Conclusion Levonorgestrel intrauterine system may be involved in the inhibiting of the expression of ER and PR and induced the recurrence of endometrial polyps.