子宫内膜异位症妇女腹腔液表皮生长因子含量的改变

为确定子宫内膜异位症(EMs)妇女腹腔液表皮生长因子(EGF)含量随着疾病的严重程度及不孕症的有无而改变的规律性,对75例妇女的腹腔液进行研究。其中25例为外在性EMs(Ⅰ～Ⅱ期13例,Ⅲ～Ⅳ期12例)的可生育妇女(1组),32例为外在性EMs(Ⅰ～Ⅱ期20例,Ⅲ～Ⅳ期12例)并发不孕症(除外其它原因所致)妇女(2组),3组(对照组)为18例健康可生育妇女。全部妇女均行腹腔镜检查,确定外在性EMs的诊断及病变严重程度,同时采集腹腔液,应用免疫酶分析法检测腹腔液EGF浓度,所得资料经统计学处理。     

子宫内膜异位症患者血清金属蛋白酶-1、组织抑制因子-1检测的临床意义

目的:探讨子宫内膜异位症患者血清金属蛋白酶-1(MMP-1)、组织抑制因子-1(TIMP-1)水平的变化及其临床意义。方法:收集44例子宫内膜异位症(EMs)患者(其中Ⅰ期8例、Ⅱ期2例、Ⅲ期20例、Ⅳ期14例)和30例对照组患者的血清,以及18例EMs患者手术加药物治疗后的血清标本,采用双抗夹心酶联免疫吸附法(ELISA)定量检测血清中MMP-1、TIMP-1的水平。结果:EMs患者血清MMP-1的水平高于对照组(P<0．05),TIMP-1的水平低于对照组(P<0．01),早期(Ⅰ-Ⅱ期)血清TIMP-1高于Ⅲ、Ⅳ期(P<0．05);手术加药物治疗后EMs患者血清TIMP-1水平可显著性提高;血清TIMP-1水平与临床分期呈直线负相关关系(P<0．01,r=-0．398)。结论:检测EMs患者血清TIMP-1的水平对EMs随访监测及评价手术药物疗效有一定价值。     

细胞间粘附分子-1在子宫内膜异位症的表达及意义

目的 探讨细胞间粘附分子-1（ICAM-1）在子宫内膜异位症发病机制中所起的作用。方法用免疫组织化学法检测子宫内膜异位症患者在位子宫内膜36例、异位子宫内膜36例及对照组子宫内膜30例ICAM-1的表达；并用酶联免疫吸附法检测子宫内膜异位症患者腹腔液47例、对照组腹腔液41例中sICAM-1的含量。结果①ICAM-1表达量的比较：子宫内膜异位症患者异位内膜〉对照组内膜〉子宫内膜异位症患者在位内膜；②子宫内膜异位症患者腹腔液sICAM-1含量明显高于对照组，P=0．0078；③Ⅰ，Ⅱ期和Ⅲ～Ⅳ期子宫内膜异位症患者腹腔液sICAM-1含量无明显差异，P=0．37。结论 ICAM-1的异常表达在子宫内膜异位症发病过程中起一定作用。     

VEGF及其受体KDR在子宫内膜异位症中的表达及意义

目的:通过检测血管内皮生长因子(VEGF)、激酶插入区受体(KDR)在子宫内膜异位症(EMs)患者异位内膜、在位内膜及血清和腹腔液中的表达,探讨VEGF及KDR在EMs发病机制中的作用。方法:应用免疫组化SP法检测并比较EMs异位内膜、在位内膜及对照组子宫内膜组织中VEGF及KDR的表达水平。应用酶联免疫吸附法(ELISA)检测并比较EMs组及对照组血清和腹腔液中VEGF及KDR的含量。结果:VEGF和KDR在EMs组异位内膜的表达明显高于在位内膜和正常内膜组(P<0.05),VEGF和KDR在在位内膜的表达明显高于正常对照组(P<0.05),且两者在EMs异位内膜的表达呈正相关(r=0.971,P<0.05)。EMs患者血清和腹腔液中VEGF及KDR含量明显高于对照组(P<0.01),临床分期较早(Ⅰ～Ⅱ)的EMs患者的血清和腹腔液中VEGF及KDR水平明显高于临床分期较晚(Ⅲ～Ⅳ)的患者(P<0.05)。EMs组腹腔液中VEGF及KDR浓度显著高于其血清中浓度(P<0.05)。结论:VEGF及KDR可能在EMs发生、发展过程中发挥了重要的作用,检测血清VEGF及KDR水平为EMs的早期诊断提供了一种新的可能方法,也为通过VEGF-VEGFR双靶向阻断血管来治疗EMs奠定了理论基础。     

PRL-3和MMP-9与子宫内膜异位症侵袭、种植关系的研究

目的:观察促肝细胞再生磷酸酶3(PRL-3)和基质金属蛋白酶9(MMP-9)在子宫内膜异位症(EMs)的表达,探讨它与子宫内膜异位症侵袭、种植的关系。方法:用SABC免疫组织化学法检测PRL-3和MMP-9在31例EMs的异位内膜及在位内膜组织、27例正常子宫内膜组织的表达。结果:PRL-3与MMP-9表达的强弱顺序均为:EMs组异位内膜>EMs组在位内膜>对照组子宫内膜,组间差异有统计学意义(P<0.05);Ⅰ~Ⅱ期的异位内膜PRL-3及MMP-9表达强度均高于Ⅲ~Ⅳ期(P<0.05),但在位内膜二者表达强度在不同临床分期中无统计学差异(P>0.05)。EMs组异位内膜的PRL-3与MMP-9表达呈正相关(P<0.05),在位内膜的PRL-3与MMP-9表达则无明显相关性(P>0.05)。结论:PRL-3和MMP-9可能与EMs的侵袭、种植密切相关。     

细胞外基质金属蛋白酶诱导因子、基质金属蛋白酶9及P38丝裂原活化蛋白激酶在子宫内膜异位症中的表达及相关性

目的探讨细胞外基质金属蛋白酶诱导因子(extracellular matrix metalloproteinase inducer,EMMPRIN)、基质金属蛋白酶9(matrix metalloproteinases-9,MMP-9)和P38丝裂原活化蛋白激酶(mitogen-activated protein kinase,MAPK)在子宫内膜异位症(endometriosis,EMs)中的表达及相关性。方法收集2008年5-12月重庆医科大学附属第一医院收治的EMs患者44例(异位内膜44例,在位内膜38例),对照组为同期非EMs患者在位内膜34例。应用免疫组化SABC三步法检测各组织中EMMPRIN、MMP-9、P38及磷酸化P385(p-P38)蛋白的表达,并对各蛋白表达水平进行相关性分析。结果 EMMPRIN、MMP-9、P38、p-P38蛋白在EMs异位内膜表达均高于EMs在位内膜组及对照组在位内膜,差异有统计学意义(P<0.05);Spearman相关分析显示,在EMs异位内膜中各蛋白表达呈正相关(P<0.05)。在EMs异位内膜组中各蛋白表达Ⅲ～Ⅳ期高于Ⅰ～Ⅱ期,差异均有统计学意义(P<0....     

子宫内膜异位症在位和异位内膜的MMPS活性分析

目的 分析子宫内膜异位症(EM)患者在位及异位子宫内膜中活化型基质蛋白酶-2、-9(MMP-2、MMP-9)、非活化型基质蛋白酶12、19(proMMPl2、proMMP-9)的酶谱及在EM发病机制中的作用。方法 2000年3月至2002年9月采用酶谱法检测16例手术治疗EM患者的异位内膜和在位内膜，16例同期住院的月经正常的良性卵巢肿瘤或子宫肌瘤的子宫内膜中的pmMMP-2、MMP-2、proMMP-9、MMP-9。结果 EM同一个体的异位内膜proMMP-2、proMMP-9活性高于在位内膜；在位内膜的proMMP-9活性无论何期明显高于对照组正常的子宫内膜；proMMP-2活性在增生期在位内膜较对照组正常内膜有上升趋势。而MMP-2及MMP-9均未见规律性趋势。结论 同一个体的异位内膜的proMMP-2、pmMMP-9活性较在位内膜增高，提示异位内膜更具侵蚀性。同为在位内膜，EM的proMMp-9活性较正常对照为高，可能与EM的发病有关。而proMMP-2活性仅在增生期表现在位内膜较对照组正常为高，可能提示增生期内膜更具侵蚀性。     

巨噬细胞与子宫内膜异位症

子宫内膜异位症(endometriosis,EMs)是妇科常见病,发病机制和病理过程目前不明确。通过测定子宫内膜异位症患者与对照组的腹腔液、在位及异位内膜组织中巨噬细胞数量及各种免疫因子的变化,发现子宫内膜异位症患者腹腔液、卵巢巨噬细胞及其代谢产物浓度增高,活性增强。证实巨噬细胞可能影响卵巢功能并在子宫内膜异位症的发生和发展过程中起重要作用。     

子宫内膜异位症中Fractalkine及其受体CX3CR1的表达及相关性研究

目的:研究趋化性细胞因子(FKN)及其受体CX3CR1在子宫内膜异位症(EMs)组织、腹腔液、血清中的表达及其意义。方法:应用免疫组化法检测正常内膜和子宫内膜异位症患者在位内膜、异位内膜中趋化性细胞因子FKN及其受体CX3CR1的表达,同时利用酶联免疫法(ELISA)检测EMs患者腹腔液和血清中趋化性细胞因子FKN及其受体CX3CR1的含量。结果:(1)正常内膜组、在位内膜组、异位内膜组组织中FKN和CX3CR1的表达呈逐渐增高趋势(P<0.05);(2)在各内膜组中FKN的表达与CX3CR1的表达呈正相关(P<0.05);(3)FKN及其受体CX3CR1在异位症组腹腔液的表达高于对照组(P<0.05);(4)FKN及其受体CX3CR1在异位症组血清中的表达与对照组比较,差异无统计学意义(P>0.05)。结论:趋化性细胞因子FKN及其受体CX3CR1参与了子宫内膜异位症患者腹腔内环境的改变;可能在在异位内膜的转移、种植中起了促进作用。     

子宫内膜异位症患者血清与腹腔液中DNA甲基转移酶的测定

目的:检测子宫内膜异位症(endometriosis,EMs)患者DNA甲基转移酶1(DNA methyltransferase,DNMT1)及DNMT3B在血清与腹腔液中的表达,探讨EMs增殖期和分泌期存在的甲基化改变。方法:选取2013年7—12月在北京大学深圳医院妇科及计划生育科行宫腹腔镜手术,并证实为EMs的患者61例作为研究组,其中Ⅰ~Ⅱ期39例(A组),Ⅲ~Ⅳ期22例(B组),选取同期行宫腹腔镜手术证实为非EMs的27例患者作为对照组(C组)。采用酶联免疫吸附试验(ELISA)测定3组增殖期和分泌期患者DNMT1及DNMT3B在血清及腹腔液中的表达。结果:1B组增殖期患者DNMT1在血清中的表达高于A组和C组增殖期患者,A、B组增殖期患者DNMT3B在血清中的表达高于C组增殖期患者,差异均有统计学意义(P0.01)。2A组增殖期患者DNMT3B在腹腔液中的表达高于B组和C组增殖期患者,差异有统计学意义(P0.01)。33组分泌期患者DNMTs在血清及腹腔液中的表达差异均无统计学意义(P0.05)。结论:增殖期时EMs体内甲基化改变明显,且EMs不同分期的甲基化状态的改变也有差异,提示增殖期DNA甲基化改变在EMs的发生发展过程中起重要作用。     

Changes in beta-endorphin in fetal membranes and placenta in normal and pathological pregnancies

Several studies indicated that trophoblast tissue synthesizes pro-opiomelanocortin-related peptides. These peptides are also present in amniotic fluid, but their origin remains unknown. The present study evaluated the presence of and the possible changes in beta-endorphin (beta-EP) in amnion and chorion during pregnancy, at parturition and in spontaneous abortion. Amnion, chorion and placental tissues were isolated and homogenized from a total of 46 pregnant women between 4th and 42 th week of pregnancy. Beta-EP was separated on a Sephadex G-75 column and measured by RIA with specific antiserum. The identity of the endogenous opioid with its corresponding reference molecule was confirmed by high performance liquid chromatography. In all tissues, the concentration of beta-EP in the first trimester was significantly higher than in the second trimester. A negative correlation between opioid levels and gestational age was observed in the first two trimesters. At delivery, the beta-EP content of all tissues was greater than in the second trimester. In tissues collected at term, in the absence of labor, beta-EP levels were very low in comparison with those collected after vaginal delivery. Low beta-EP contents were found in membranes collected from spontaneous abortion in 1st trimester. From these data one can surmise the existence of a local endogenous opioid system in fetal adnexes. This system seems sensitive to the stress of vaginal delivery and could be involved in the mechanisms leading to spontaneous abortion.     

Differences in preterm delivery rates and outcomes in Jews and Bedouins in Southern Israel

OBJECTIVE: (1) To compare the preterm delivery rates in the Bedouin versus the Jewish population. (2) To compare risk factors for preterm delivery in the two populations. (3) To compare outcomes of preterm delivery between the two groups. STUDY DESIGN: 41669 Jewish singletons births of whom 2816 delivered preterm (23-36 weeks) and 26495 Bedouin singletons in whom 2064 preterm deliveries occurred, were compared. All births took place in Soroka University Medical Center. Data were obtained from the computerized database of birth discharge records. RESULTS: The incidence of preterm delivery in Bedouin women was significantly higher than the rate in Jewish women (7.8 vs. 6.8%, P<0.01). The grand multiparity rate was higher among Bedouin women (P<0.001), as was the rate of teenage (<19 years) mothers (P<0.001). Gestational diabetes, PIH, and PROM rates were higher in the Jewish population (P<0.001, P=0.017, P<0.001, respectively). A bad obstetric history and previous perinatal mortality is more common in the Bedouin population (P<0.001 for both). In a logistic regression model including all these factors, the ethnic difference in the incidence of preterm delivery remained significant. The neonatal mortality rate was higher in the Bedouin population (P<0.001), as was the rate of congenital malformations (P<0.001). The perinatal mortality of Bedouins was nearly twice that of Jewish neonates with congenital malformations. However, no difference was found when neonates without congenital malformations were compared. Congenital malformations were found to be the strongest predictor of mortality. Ethnicity per se was no longer a predictor of mortality once congenital malformations were included in a logistic regression model, but the interaction of Bedouin ethnicity and congenital malformation was a significant predictor of mortality. CONCLUSION: The incidence of preterm delivery was significantly higher in Bedouin women than in Jewish women. A full explanation for this difference was not found. However, there were significantly higher rates of congenital malformations in the Bedouin preterm delivered infants. There was a much higher rate of neonatal mortality in the Bedouin population and this ethnic difference was fully explained by the presence of congenital anomalies.