BDNF及TrKB在子宫内膜异位症在位内膜和异位病灶组织中的表达及意义

Expression and significance of BDNF and Tr KB in eutopic and ectopic endometrium of endometriosis

目的探讨脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)及其受体酪氨酸激酶受体B(tyrosine receptor kinase B,Tr KB)在子宫内膜异位症(endometriosis,EMS)在位内膜和卵巢异位病灶的表达,及其与分期和痛经的关系。方法选取2016年5月至11月在首都医科大学附属北京妇产医院妇科微创中心因卵巢EMS手术的患者40例,按r-AFS分期进行评分,其中Ⅲ期19例为Ⅲ期组,Ⅳ期21例为Ⅳ期组;并选取因卵巢良性上皮性肿瘤行手术的患者16例为对照组。采用免疫组化染色法检测Ⅲ期组和Ⅳ期组卵巢异位病灶、在位内膜与对照组子宫内膜中BDNF、Tr KB水平,分析其与分期及痛经视觉模拟评分(visual analogue scale,VAS)的关系。结果 (1)BDNF、Tr KB在Ⅲ期组和Ⅳ期组在位内膜的表达分别为(1.9±0.3、2.2±0.4)、(2.0±0.3、2.3±0.2)。两两比较,Ⅳ期组均高于Ⅲ期组,并均高于两者在对照组子宫内膜的表达(1.2±0.1、1.2±0.1),差异均有统计学意义(P<0.05)。(2)BDNF、Tr KB在Ⅲ期组和Ⅳ期组卵巢异位病灶的表达分别为(2.4±0.5、2.7±0.4)、(2.3±0.6、3.4±0.3)。两两比较,Ⅳ期组均高于Ⅲ期组,差异均有统计学意义(P<0.05)。(3)BDNF、Tr KB在Ⅲ期组和Ⅳ期组在位内膜的表达水平与痛经VAS评分呈正相关(r=0.478、0.386,P<0.05)。(4)BDNF、Tr KB在Ⅲ期组和Ⅳ期组的在位内膜、卵巢异位病灶的表达,增殖期与分泌期比较,差异均无统计学意义(P>0.05)。结论 BDNF及Tr KB随EMS病变程度加重其表达增加,推测BDNF及Tr KB可能参与EMS的发生发展,在一定程度上参与EMS疼痛的发生。

Objective To investigate the expression of brain -derived neurotrophic factor（BDNF） and tyrosine receptor kinase B （TrKB） in endometriosis （EMS）, and discuss the relationship between their expression and EMS stage or dysmenorrheal symptoms. Methods 40 patients underwent surgery for ovarian endometrioma（OMA） from May to November 2016 were selected in Gynecological Minimally Invasive Center of Beijing Obstetrics and Gynecology Hospital, Capital Medical University. According to r - AFS staging, 19 cases in stage III were stage III group and 21 cases in stage IV were stage IV group. 16 patients underwent surgery because of benign epithelial ovarian tumor were selected as the control group. The expression of BDNF and TrKB was detected by immunohistochemical staining and the relationship between the expression of two molecules and stages of EMS, visual analogue scale（VAS） of dysmenorrheal symptoms were investigated. Results （1） The expression of BDNF and TrKB in eutopic endometrium of stage III group and stage IV group was （ 1.9 ± 0. 3,2. 2 ± 0. 4） and （ 2.0 ± 0. 3,2. 3 ±0. 2）. The expression of stage IV group was higher than stage III group, both were higher than those in endometrium of the control group （P 〈 0. 05 ）. （2） The expression of BDNF and TrKB in OMA of stage III group and stage IV group was （2.4 ±0. 5,2. 7 ±0.4） and （2. 3 ±0. 6,3.4 ±0. 3）, those in stage IV group was higher than stage III group（P 〈 0.05）. （3） The expression of BDNF and TrKB in eutopic endometrium of stage III group and stage IV group was positively related to VAS of dysmenorrhea（ r = 0. 478, 0. 386, P 〈 0.05 ）. （4） There were no differences between the expression of BDNF or TrKB in proliferation phase and the secretory phase in both eutopic endometrium and OMA of stage III group and stage IV group. Conclusion The expression of BDNF and TrKB may increased depend on exacerbation of endometriosis, suppose BDNF and its receptor TrKB may promote the occurrence and development of EMS, may also play a part in the dysmenorrhea of EMS.