雌激素受体及孕激素受体在肝内及肝外胆管癌中的表达

 目的　对比研究雌激素受体（ER）、孕激素受体（PR）在肝内、外胆管癌中的表达情况。方法　应用免疫组织化学法,检测24例肝内胆管癌和34例肝外胆管癌组织中ER和PR的表达水平。结果　在肝内胆管癌中,ER和PR的阳性表达率分别为29 %（7／24）和46 %（11／24）,组织学分级高分化组的9例中3例ER阳性表达,中分化组的11例中3例阳性表达,低分化组的4例中1例阳性表达;不同分级中,PR阳性表达分别为2、7、2例,各组织学分级间ER和PR的表达差异无统计学意义（均P＞0.05）。ER和PR在34例肝外胆管癌中均呈阴性表达。结论　ER和PR在肝内、外胆管癌中的表达水平明显不同,仅表达于肝内胆管癌,可能参与了肝内胆管癌的发生过程。     

黄体酮治疗先兆性流产的临床疗效观察

目的 探讨黄体酮治疗因黄体功能不全而引起的先兆性流产的临床疗效.方法 选取2010-2012年在我院门诊治疗的符合条件的先兆性流产患者128例,采用肌肉注射黄体酮注射液治疗,观察临床治疗效果.结果 肌肉注射黄体酮注射液治疗因黄体功能不全而引起的先兆性流产的有效率为91.4%,不良反应比较轻,并且发生率较低.结论 黄体酮治疗因黄体功能不全而引起的先兆性流产的疗效确切、安全、可靠,可在临床上推广使用.     

子宫非典型息肉样腺肌瘤九例临床分析及文献复习

目的:探讨子宫非典型息肉样腺肌瘤(atypical polypoid adenomyoma,APA)的治疗和随访策略。方法:对我院2008—2016年收治的9例APA患者的临床资料进行回顾性分析。结果:9例患者的平均年龄为37.4(20~50)岁。其中3例为单纯APA;1例为APA合并子宫内膜样腺癌;1例为APA合并子宫内膜不典型增生;1例为APA,而后随访病理为子宫内膜复杂型不典型增生;1例为子宫内膜复杂型不典型增生,而后随访病理为APA与子宫内膜复杂型不典型增生共存;1例为APA,而后随访病理为子宫内膜复杂型增生;1例为APA与子宫内膜复杂型增生并存。3例初始治疗为分段诊刮术,6例为经宫腔镜病灶切除。随访截至2017年1月,平均随访45.5(3~103)个月,9例APA患者均未见复发、癌变,3例原发不孕患者均尚未妊娠。结论:APA临床上虽为良性疾病,但由于其潜在恶性应积极治疗,而且其治疗方案应依据患者年龄、腺体组织结构异型指数、子宫内膜情况以及是否有生育要求来决定。     

人绒毛膜促性腺激素注射前血清孕激素升高的持续时间对体外受精-胚胎移植的影响

目的:探讨在控制性促排卵(COS)过程中人绒毛膜促性腺激素(h CG)注射前孕激素水平升高的持续时间对体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法:选取2012年1月—2014年12月在安徽医科大学附属省立医院生殖医学中心行IVF-ET或胞浆内单精子注射(ICSI)-ET助孕的1 132例不孕症患者的临床资料。根据h CG注射日血清孕激素水平分4组:A1组h CG注射日孕激素水平3.18 nmol/L,共521例;A2组h CG注射日孕激素水平3.18~6.36 nmol/L,共338例;A3组h CG注射日孕激素水平6.36~7.95 nmol/L,共197例;A4组h CG注射日孕激素水平7.95 nmol/L,共76例。根据h CG注射前(包括h CG注射日及前一日)血清孕激素水平持续2天在同一范围的患者分为3组:B1组孕激素水平3.18 nmol/L,共220例;B2组孕激素水平3.18~6.36 nmol/L,共116例;B3组孕激素水平6.36 nmol/L,共62例。对上述各组的临床资料进行回顾性分析,比较各组患者的促排卵效果及周期妊娠结局。结果:h CG注射日不同孕激素水平的4组患者年龄、不孕年限、促性腺激素(Gn)天数、Gn用量、获卵数、正常受精率、可移植胚胎率和优质胚胎率的比较差异均无统计学意义(均P0.05)。A4组与A1组比较,胚胎种植率、生化妊娠率、临床妊娠率和活产率差异均具统计学意义(均P0.008)。与B1组相比,B2组和B3组的胚胎种植率、临床妊娠率及活产率下降,差异有统计学意义(均P0.017),B3组的生化妊娠率也比B1组低,差异有统计学意义(P0.017)。结论:COS过程中,h CG注射日孕激素水平7.95 nmol/L及h CG注射前连续2天孕激素水平≥3.18 nmol/L对IVF-ET的妊娠结局具有负面影响。     

子宫内膜癌PR、ER、PTEN、p53及Ki-67的表达情况及其与预后的相关性分析

目的 探讨子宫内膜癌孕激素受体(PR)、雌激素受体(ER)、磷酸酶与张力蛋白同源物(PTEN)、p53及Ki-67与临床病理特征和预后的相关性.方法 选取2008年7月-2009年1月收治的子宫内膜癌198例,收集患者临床、病理及术后随访等资料,对PR、ER、PTEN、p53及Ki-67与临床病理特征的关系和对预后的影响进行相关性分析.结果 ER阳性表达率在病理分型、FIGO分级、组织病理学分期、肌层浸润程度中比较差异有统计学意义(P＜0.05);不同病理分型、组织病理学分期中PR阳性表达率比较差异有统计学意义(P＜0.05);p53阳性表达率随组织病理分级越高表达水平越高,与病理分型有关(P＜0.05);Ki-67随着组织病理学分级越高表达水平越高(P＜0.05).FIGO分级Ⅲ～Ⅳ期、有淋巴结转移、PR阴性表达是影响子宫内膜癌患者预后生存的危险因素(P＜0.01).结论 PR表达水平与子宫内膜癌患者预后密切相关.     

孕激素治疗子宫内膜异位症的现状及进展

子宫内膜异位症（endometriosis，EMs）是妇科常见、良性、慢性疾病，需长期或重复性使用药物来控制相关症状。手术是治疗EMs的常用方法，但单纯手术复发率高，术后患者常需辅助药物治疗。EMs是一种雌激素依赖性疾病，药物治疗的目的是营造低雌激素环境，抑制异位内膜的生长或使之萎缩。孕激素因具有良好的耐受性、轻微的代谢影响及相对较低的成本，成为目前术后治疗EMs唯一安全且经济的首选药物，而左炔诺孕酮宫内缓释系统特别适用于合并子宫腺肌病的EMs患者。针对个体状况的不同，孕激素治疗方案的选择不同，选择治疗方案时应考虑药物不良反应及其准确的作用机制。就孕激素治疗EMs最新分子机制的研究、常用种类、常用剂型和剂量及其应用前景等方面作一综述。     

Dorsal hippocampal progesterone infusions enhance object recognition in young female mice

The effects of progesterone on memory are not nearly as well studied as the effects of estrogens. Although progesterone can reportedly enhance spatial and/or object recognition in female rodents when given immediately after training, previous studies have injected progesterone systemically, and therefore, the brain regions mediating this enhancement are not clear. As such, this study was designed to determine the role of the dorsal hippocampus in mediating the beneficial effect of progesterone on object recognition. Young ovariectomized C57BL/6 mice were trained in a hippocampal-dependent object recognition task utilizing two identical objects, and then immediately or 2 h afterwards, received bilateral dorsal hippocampal infusions of vehicle or 0.01, 0.1, or 1.0 μg/μl water-soluble progesterone. Forty-eight hours later, object recognition memory was tested using a previously explored object and a novel object. Relative to the vehicle group, memory for the familiar object was enhanced in all groups receiving immediate infusions of progesterone. Progesterone infusion delayed 2 h after training did not affect object recognition. These data suggest that the dorsal hippocampus may play a critical role in progesterone-induced enhancement of object recognition.     

雌、孕激素对子宫内膜癌细胞孤儿受体ERRα的调控作用

目的:探讨孤儿受体ERRα与雌激素(E)、孕激素(P)之间的相互关系及其在子宫内膜癌发病中的作用.方法:采用逆转录聚合酶链反应(RT-PCR)方法,检测不同浓度(10-10,10-8,10-6mol/L)17β-雌二醇(17β-E2)作用于Ishikawa细胞系不同时间(0 min,15 rmin,30 min和24 h)后ERRα mRNA的变化,并应用ER拮抗剂ICI182780同时作用细胞,观察是否可阻断E2对ERRα的调控作用;检测不同浓度孕酮(10-8,10-7,10-6,10-5mol/L)作用于Ishikawa细胞系24 h后ERRα mRNA的变化.结果:10-10mol/L 17β-E2作用于Ishikawa细胞系15 min,30 min及24 h后ERRα mRNA水平与未加E2相比均稍有增加,而10-8,10-6mol/L 17β-E2作用于细胞系15 min,30 min及24 h后ERRα mRNA明显减小,以10-8mol/L作用后减少最明显.同时加入E2和ICI182780作用于细胞系后,E2对ERRα mRNA的减小作用被阻断.10-8mol/L孕酮作用于细胞系24 h后,ERRα mRNA与对照组相比无明显变化,但加入10-7,10-6和10-5mol/L孕酮后,ERRα mRNA表达均出现明显增加.结论:17β-E2可减少子宫内膜癌细胞系Ishikawa细胞ERRα mRNA的表达,此减少作用是通过ER介导完成的.孕酮可增加ERRα mRNA的表达.     

The pharmacodynamics and safety of progesterone

Natural progesterone (P4) has a unique pharmacodynamic activity and safety profile compared to the synthetic progestins. As a result, a class effect does not exist for both P4 and synthetic progestins, in terms of both their efficacy and safety.Progestogens act at the genomic level by binding to the nuclear receptors and modulating the expression of some target-genes. P4 and the synthetic progestins have a hugely variable affinity for binding not only to the P4 receptors but also to other members of the steroid receptor family including glucocorticoid receptor, androgen receptor and mineralocorticoid receptor. This leads to different and specific pharmacokinetic profiles, clinical pharmacodynamics, safety and efficacy.P4 produced in the luteal phase of the menstrual cycle has several physiological effects regulating menses and, in the pregnant uterus, controlling the development of endometrial receptivity preparing the endometrium for implantation.P4 and its associated metabolites are powerful biological agents through genomic action by the progesterone nuclear receptor with a finely tuned regulatory role throughout pregnancy, from conception until delivery. Extra-nuclear, non-classical mechanisms of action have also been identified, including steroid interactions with some membrane receptors [oxytocin receptors and γ-aminobutyric acid (GABA_A), and the induction of a direct relaxing effect on uterine contractility by blockage of calcium influx.The extent of activity of P4 on the central nervous system (CNS) is modulated by the route of administration: oral P4 is affected by the presence of bacteria and associated enzymes secreted in the gut, the intestinal wall and by the liver, whereas vaginal P4 is not. P4 and two important metabolites, namely, allopregnanolone (3a,5a-tetrahydroP4) and 3a,5a-tetrahydrodeoxycorticosterone, exert neuroprotective effects on neonates. They are also natural positive modulators of the neuronal GABA_A receptor, providing a clear pathway to explain the rapid dose-dependent psychopharmacological actions including anxiolytic, antidepressant, anaesthetic, anticonvulsant and analgesic effects.Fundamental structural differences exist between P4 and the synthetic progestins, resulting in different safety profiles when they are used during the menstrual cycle, in early and late pregnancy and in the alleviation of peri- or postmenopausal symptoms.