子宫内膜息肉患者增殖期及种植窗期性激素及激素受体的改变及意义

Expression and Significance of Sex Hormone and Its Receptors in the Proliferative Phase and in the Implantation Window of Endometrial Polyps

目的:探讨子宫内膜息肉不孕患者增殖期及种植窗期性激素及雌激素受体(ER)和孕激素受体(PR)的改变及意义。方法:选择100例宫腔镜检查见赘生物并经病理证实为子宫内膜息肉(EP)的患者作为EP组,其中,增殖期检查者50例,种植窗期检查者50例。选择60例已生育宫腔镜检查示宫腔正常并经病理证实者作为对照组,其中,增殖期检查者30例,种植窗期检查者30例。采用化学发光法测定患者血清的性激素水平,免疫组织化学方法检测子宫内膜组织中雌激素受体(ER)、孕激素受体(PR)的表达,并进行比较。结果:EP组血清基础雌二醇(E2)水平显著高于对照组(235.59±109.47 pmol/L vs 159.89±87.48 pmol/L,P<0.05),EP组种植窗期孕酮(P)/E2比值显著低于对照组(0.077 vs 0.090,P<0.05),其他各项性激素指标及ER各组及各期间比较,差异均无统计学意义(P>0.05)。PR在EP组EP组织种植窗期子宫内膜间质中的表达显著低于EP周围正常内膜与对照组(P<0.05)。结论:对于无月经改变的子宫内膜息肉患者,长期较高水平的E2刺激,PR在分泌期EP间质中处于低水平、相对不足状态可能与息肉形成有关。

Objective: To explore the expression and significance of sex hormone, estrogen receptor(ER)and progesterone receptor(PR) in the proliferative phase and in the implantation window of endometrial polyps(EP) diagnosed in infertile patients. Methods: A total of 100 infertile patients with EPs confirmed by hysteroscopy and pathology were recruited, with 50 cases examined in the proliferative phase, and 50 cases examined in the midsecretory phase. Meanwhile, 60 infertile patients with normal uterine cavity confirmed by hysteroscopy and pathology were chosen as control group, with 30 cases examined in the proliferative phase, and 30 cases examined in the midsecretory phase. The expressions of ER and PR were detected by immunohistochemistry, and the serum sex hormone was determined by chemiluminescence. Results: Compared with the control, serum estradiol(E2)level was significantly higher in EP group(235.59±109.47 pmol/L vs 159.89±87.48 pmol/L, P<0.05), while the ratio of P/E2 was significantly lower(0.077 vs 0.090, P<0.05), and there were no differences of the other indexes of sex hormone between the two groups(P>0.05). The ER expressions of glandular epithelial cells and stromal cells were not statistically different between EP, normal endometrium surrounding EP and control group, no matter in the proliferative phase or in the implantation window(P>0.05). The PR expressions of glandular epithelial cells and stromal cells were also similar between three groups in the proliferative phase(P>0.05). In the implantation window, the PR expressions of glandular epithelial cells did not differ among three groups(P>0.05), however, the PR expressions of stromal cells in EP was significantly lower than that in normal endometrium surrounding EP and control group(P<0.05). Conclusion: With regard to EP without menstruation change in infertile patient, the long-term stimulation of higher estradiol level along with lower level and relatively insufficiency expression of PR in the endometrial stroma in secretary phase may be associated with the pathogenesis of EP.