蜕膜组织种植建立子宫内膜异位症模型的可行性分析

Feasibility analysis of establishing endometriosis model by decidua tissue implantation

目的探讨蜕膜组织中胎盘生长因子(PLGF),雌激素受体(ER)-α、-β表达特性,为建立子宫内膜异位症(EMS)模型提供理论依据。方法选择2016年8月至2017年2月,于南通大学第二附属医院就诊的101例女性为研究对象。术中在无菌条件下,分别获取其中38例剖宫产术孕妇子宫内的蜕膜组织38例,37例EMS患者(其中31例合并子宫肌瘤)的在位内膜31例及异位内膜37例,26例子宫肌瘤患者的正常内膜26例。采用免疫组织化学和实时荧光定量聚合酶链反应(qPCR)技术,检测这4种子宫内膜组织中PLGF,ER-α、-β的阳性表达率及其mRNA相对表达量。对蜕膜组织中的PLGF,EF-α、-β与其他3种子宫内膜组织中的这3种因子阳性表达率及其mRNA相对表达量分别进行统计学比较。本研究所有受试者均知情同意。结果 (1)免疫组织化学方法检测结果显示:蜕膜组织中PLGF,ER-α、-β的阳性表达率(86.8%、84.2%、78.9%),均分别高于在位内膜(61.3%、58.1%、38.7%)、异位内膜(54.1%、35.1%、48.6%)及正常内膜(57.7%、53.8%、38.5%),并且差异均有统计学意义(χ~2=6.003、5.849、15.298;χ~2=9.723、18.812、7.469;χ~2=6.996、7.041、10.796;均为P<0.05)。(2)qPCR检测结果显示:蜕膜组织PLGF,ER-α、-βmRNA相对表达量[(2.60±0.26)、(2.22±0.23)、(2.05±0.31)],均分别高于在位内膜[(1.23±0.09)、(1.08±0.13)、(0.95±0.14)],异位内膜[(1.96±0.22)、(0.38±0.06)、(1.50±0.35)]及正常内膜[(1.00±0.13)、(1.00±0.11)、(1.00±0.14)],并且差异均有统计学意义(t=21.243、15.263、15.382;t=9.939、20.093、8.112;t=20.532、15.628、17.282;均为P<0.001)。结论蜕膜组织具有较强的种植特性,有助于形成子宫内膜异位病灶,是建立EMS模型的良好载体。

Objective To explore the expression characteristics of placental growth factor（PLGF）,estrogen receptor（ER）-αand ER-βin decidua tissue,and to provide a theoretical basis for the establishment of endometriosis（EMS）model.Methods From August 2016 to February 2017,a total of 101 women in Second Affiliated Hospital of Nantong University were selected as research subjects.Under the aseptic condition,a total of 38 cases of decidua tissue were obtained from 38 pregnant women of caesarean section,31 cases of eutopic endometrium and 37 cases of ectopic endometrium were obtained from 37 cases of EMS patients（including 31 cases with hysteromyoma）,and 26 cases of normal endometrium were obtained from 26 cases of hysteromyoma patients.Immunohistochemistry and quantitative real-time polymerase chain reaction（qPCR）were used to detect the positive expression rate and mRNA relative expression levels of PLGF,ER-αand ER-βin these 4 types of endometrium tissues.The positive expression rate and mRNA relative expression levels of 3 factors in decidua tissue were statistically compared with those in other 3 endometrial tissues,respectively.All subjects in this study signed informed consents.Results（1）The results of immunohistochemical staining showed that the positive expression rates of PLGF,ER-αand ER-βin decidua tissue（86.8%,84.2%,78.9%）were all higher than those in eutopic endometrium（61.3%,58.1%,38.7%）,ectopic endometrium（54.1%,35.1%,48.6%）and normal endometrium（57.7%,53.8%,38.5%）,respectively,and all the differences were statistically significant（χ~2=6.003,5.849,15.298;χ~2=9.723,18.812,7.469;χ~2=6.996,7.041,10.796,all P〈0.05）.（2）The results of qPCR detection showed that the mRNA relative expression levels of PLGF,ER-αand ER-βin decidual tissue[（2.60±0.26）,（2.22±0.23）,（2.05±0.31）],were all higher than those in eutopic endometrium [（1.23±0.09）,（1.08±0.13）,（0.95±0.14）],ectopic endometrium [（1.96±0.22）,（0.38±0.06）,（1.50±0.35）]and normal endometrium [（1.00±0.13）,（1.00±0.11）,（1.00±0.14）],respectively,and all the differences were statistically significant（t=21.243,15.263,15.382;t= 9.939,20.093,8.112;t= 20.532,15.628,17.282;all P〈0.001）.Conclusions Decidua tissue has strong planting characteristics which are helpful to the formation of ectopic lesions,and it provides a good carrier for the establishment of EMS model.