补肾活血中药对无排卵功血患者子宫内膜雌孕激素受体的影响

Effect of Kidney-Tonifying and Blood-Activating Herbal Medicines on Estrogen and Progesterone Receptor Levels in Human Endometrium of Anovulatory Dysfunctional Uterine Bleeding Patients

[目的]探讨中西药物治疗无排卵功能失调性子宫出血(功血)的机理。[方法]采用酶联免疫分析技术和 SP免疫组化半定量检测技术,对37例无排卵功血患者经补肾活血中药宫血饮(主要由补骨脂、川续断、山茱萸、蒲黄、三七、党参、生龙骨、生牡蛎、白花蛇舌草等组成)或西药黄体酮治疗前后进行血清雌、孕激素(E_2、P)及子宫内膜雌、孕激素受体(ER、PR)测定。[结果]无排卵功血患者血清E_2水平和子宫内膜ER、PR水平均较对照组高,且ER、PR含量依子宫内膜的增生程度和类型的不同呈现下降趋势,即单纯增殖症>复杂增生>增生期。经合成孕激素治疗后,血清E_2水平和子宫内膜ER、PR水平均降低。补肾活血中药宫血饮亦能降低ER、PR水平,但对血清E_2影响不大。【结论】中药与合成孕激素治疗无排卵功血的作用机理不同,它并非通过降低血清雌激素的水平而达到治疗目的,推测它可能是通过非甾体激素途径,启动了各方面的因素影响ER、PR的合成而发挥其治疗作用的。

【Objective】To explore the therapeutic mechanism of Chinese herbal medicine and western medicine in treat- ing anovulatory dysfunctional uterine bleeding (ADUB). 【Methods】Eleven cases of infertility with regular menstruation were in blank control group (Group A); 37 cases of ADUB were randomized into two groups: Group B was treated with Gongxue Yin and Group C with progesterone. Serum levels of estrogen (E_2) and progesterone (P), and levels of estro- gen receptor (ER) and progesterone receptor (PR) in human endometrium were detected with enzyme immunoassay method and solid-phase semi-quantitative immunohistochemical method. 【Results】 Serum E_2 level and ER and PR levels in endometrium were higher in ADUB than those in Group A; ER and PR levels were in the decreasing sequence in ADUM with simple hyperplasia, hyperplasia and complex hyperplasia of endometrium. After treatment, serum E_2 level and ER and PR levels in endometrium were decreased in Group C; ER and PR levels were also decreased in Group B while serum E_2 level remained unchanged. 【Conclusion】The therapeutic mechanism of Chinese herbal medicine in treating ADUB is different from western medicine; it is related to the regulation of synthesis of ER and PR through the down-regulation of non-steroid hormones, not by decreasing the serum E_2 level.