雌激素受体不同亚型在卵巢子宫内膜异位症在位内膜与异位内膜中的表达及其意义

目的 研究雌激素受体(ER)不同亚型在子宫内膜异位症的在位和异位内膜中的表达,以寻找其在不同病灶中的分布规律,探讨子宫内膜异位症的发病机制.方法 收集解放军总医院2004年1月-2006年12月行手术治疗的卵巢子宫内膜异位症石蜡标本,包括卵巢子宫内膜异位囊肿60例及其在位内膜60例(增生期各30例、分泌期各30例)以及正常子宫内膜30例(增生期和分泌期各15例).采用免疫组织化学(EnVision)方法检测上述组织中ERα和ERβ的表达.染色结果半定量化,并分析比较各种组织间的表达差异.结果 各组中,ERα和ERβ在腺上皮的表达与它们在间质细胞中的表达呈正相关.ERα蛋白在不同部位的表达:在位内膜ERα的表达(腺上皮和间质细胞阳性率分别为73.3%和76.7%)高于卵巢子宫内膜异位囊肿(腺上皮和问质细胞阳性率分别为43.4%和46.7%)和正常内膜的表达(腺上皮和间质细胞阳性率分别为56.7%和50.0%),均P<0.05.ERβ蛋白在不同部位的表达:卵巢子宫内膜异位囊肿(腺上皮和间质细胞阳性率分别为90.0%和76.7%)高于在位子宫内膜的表达(腺上皮和间质细胞阳性率分别为68.0%和63.3%),后者又高于正常子宫内膜(腺上皮和间质细胞阳性率分别为36.7%和26.7%),P均<0.05.在位内膜的ERα和ERβ蛋白表达在增殖期均高于分泌期,P均<0.05;异位内膜增殖期和分泌期的表达差异无统计学意义.ERα和ERβ蛋白在不同部位表达的比较:在正常内膜中ERα的表达略高于ERβ,但差异无统计学意义,P>0.05;卵巢子宫内膜异位囊肿中ERβ的表达高于ERα,P<0.05;而在位内膜中两种亚型表达差异无统计学意义.结论 子宫内膜异位症患者在位子宫内膜及异位内膜均有ERα和ERβ的表达,但与正常子宫内膜相比,在卵巢子宫内膜异位囊肿中ERβ表达占优势,而ERα表达受限.ERα和ERβ在不同组织中的分布及表达水平与子宫内膜异位症的发生和发展有着密切关系.

Study on expression of estrogen receptor isoforms in eutopic and ectopic endometrium of ovarian endometriosis

Objective To investigate the distribution of ER isoforms in endometnosis and eutopic endometrium. Methods Tissue samples of patients with ovarian endometriosis, treated in People's Liberation Army General Hospital from January 2004 to December 2006, were retrieved. A total of 60 cases of ovarian endometriotic cysts with their corresponding eutopic endometrinm( 30 cases of proliferation phase and 30 of secretary phase eutopic endometrium) and 30 cases of normal endometrium ( 15 proliferative and 15 secretary phase endometrial samples respectively) were included. Expressions of ERα and ERβ were analyzed using immunohistochemistry and the expression ratio was statistically analyzed by using SPSS 12.0 software. Results Expressions of both ERα and ERβ in epithelial cells were positively correlated with that of the stromal cells. The expression of ERα in eutopic endometrium (73. 3% in epithelium and 76. 7% in stroma) was significantly higher than that in ovarian endometriotic cysts (43. 3% in epithelium and 46.7% in stroma),or normal control(56.7% in epithelium and 50.0% in stroma,respectively,each P<0.05. However,the expression of ERβ(90.0% in epithelium and 76.7% in stroma)was highel in ovarian endometriotic cysts than that in the eutopic endometrium (68.0% in epithelium and 63.3%in stroma respectively,P<0.05),and ERB expression in eutopic endometrium Wa8 higher than that in the normal control endometrium(36.7% in epithelium and 26.7% in stroma,respectively,P<0.05).The expressions of both ERα and ERβ changed periodically in eutopic and nornud endometrium,whereas ERα and ERβ level were less variable in the ectopic endometrium The expression of ERβ wag statistically higher than that of ERα(P<0.05)in ectopic endometrium,whereas no significant diffefence was seen between the two isoforms in the eutopic or normal endometrium.Conclusions Both ERαand ERβ have higher expression levels in eutopic endometrim of patients with ovarian endometriotic cysts.ERβ is predominantly expressed in endometriotic cysts,where the expression of ERα is limited.The different distribution of ERα and ERβ may play an important role in tIIe development of ovarian endometriosis.