p27、cyclin-E在子宫内膜异位症中的表达及其临床意义

目的探究p27蛋白、细胞周期素E（cyclin-E）在子宫内膜异位症（EMT）患者中的表达及与患者临床病理特征、妊娠关系。 方法选取2016年1月至2021年1月江西省九江市妇幼保健院81例EMT合并不孕患者为EMT组，另选择同期60例非EMT患者为对照组。采用免疫组化法检测子宫内膜组织p27蛋白、cyclin-E表达情况，以半定量法评价镜下染色强度、阳性细胞百分比，统计p27蛋白、cyclin-E阳性表达情况。 结果EMT组异位内膜、在位内膜组织p27蛋白阳性率55.56%、58.02%，均显著低于对照组正常内膜组织的81.67%（P＜0.05），EMT组异位内膜、在位内膜组织cyclin-E阳性率69.14%、51.85%均显著高于对照组的25.00%（P＜0.05）。81例EMT患者中，浸润型异位内膜组织p27蛋白阳性率36.36%较卵巢型的62.71%下降、cyclin-E阳性率90.91%较卵巢型的62.07%升高（P＜0.05），Ⅲ~Ⅳ期异位内膜组织p27蛋白阳性率39.02%较Ⅰ~Ⅱ期的72.50%下降、cyclin-E阳性率82.93%较Ⅰ~Ⅱ期的55.00%升高（P＜0.05）。Spearman相关分析显示，p27蛋白表达与cyclin-E表达、美国生育协会分类系统（rAFS）评分呈负相关（P＜0.05），与子宫内膜容受性Salle评分呈正相关（P＜0.05）；cyclin-E表达与Salle评分呈负相关（P＜0.05），与rAFS评分呈正相关（P＜0.05）。81例患者术后24个月累计妊娠共38例（46.91%），其中p27蛋白表达阳性者妊娠率57.78%，较阴性者的33.33%高（P＜0.05），而cyclin-E表达阳性者妊娠率37.50%，较阴性者的68.00%低（P＜0.05）。调整年龄、体重指数、月经周期、术前痛经数字评分（NRS）评分、Salle评分、美国生育协会分类系统（rAFS）评分等因素后发现，cyclin-E表达阳性是术后24个月妊娠结局的影响因素（P＜0.05）。 结论p27蛋白在EMT患者中呈低表达、cyclin-E呈高表达，二者均与患者临床分型、分期及病情严重程度表现出一定相关性，其中cyclin-E高表达可能与患者妊娠结局有关。

Clinical significance of expression of p27 and cyclin E in endometriosis

ObjectiveTo detect the expression of p27 and cyclin E in patients with endometriosis (EMT) and analyze their relationship with clinicopathological characteristics and pregnancy. MethodsEighty-one patients with EMT complicated with infertility treated at Jiujiang Maternal and Child Health Hospital, Jiangxi Province between January 2016 and January 2021 were selected as an EMT group, and another 60 patients without EMT treated during the same period were included in a control group. Immunohistochemistry was used to detect the expression of p27 and cyclin E in endometrial tissues, and the staining intensity and the percentage of positive cells were evaluated by semi-quantitative method. The positive expression status of p27 and cyclin E was statistically analyzed. ResultsIn the EMT group, the positive rate of p27 was 55.56% in ectopic endometrial tissues and 58.02% in eutopic endometrial tissues, both of which were significantly lower than that in normal endometrial tissues of the control group (81.67%; P＜0.05); the positive rate of cyclin E was 69.14% in ectopic endometrial tissues and 51.85% in eutopic endometrial tissues, both of which were significantly higher than that of the control group (25.00%; P＜0.05). Among 81 patients with EMT, the positive rate of p27 in infiltrating ectopic endometrial tissue was lower than that in ovarian type (36.36% vs 62.71%, P＜0.05), while the positive rate of cyclin E was higher than that of ovarian type (90.91% vs 62.07%, P＜0.05). The positive rate of p27 in stage Ⅲ-Ⅳ ectopic endometrial tissues was lower than that in stage Ⅰ-Ⅱ (39.02% vs 72.50%, P＜0.05), while the positive rate of cyclin E was higher in stage Ⅲ-Ⅳ ectopic endometrial tissues than in stage Ⅰ-Ⅱ (82.93% vs 55.00%, P＜0.05). Spearman correlation analysis showed that p27 protein expression was negatively correlated with cyclin E expression and revised American Fertility Society (rAFS) score (P＜0.05), but was positively correlated with endometrial receptivity Salle score (P＜0.05). cyclin E expression was negatively correlated with Salle score (P＜0.05) and positively correlated with rAFS score (P＜0.05). A total of 38 (46.91%) of 81 patients were pregnant at 24 months after surgery. The pregnancy rate of patients with positive expression of p27 was higher that of p27 negative patients (57.78% vs 33.33%, P＜0.05), while the pregnancy rate of patients with cyclin E positive expression was lower than that of cyclin E negative patients (37.50% vs 68.00%, P＜0.05). After adjusting for age, body mass index, menstrual cycle, preoperative dysmenorrhea Numeric Rating Scale (NRS) score, Salle score, rAFS score, and other factors, it was found that the positive expression of cyclin-E was the influencing factor of pregnancy outcomes at 24 months after surgery (P＜0.05). Conclusionp27 protein expression is low and cyclin E expression is high in patients with EMT, and the two are correlated with the clinical type, stage, and disease severity. High expression of cyclin E may be related to the outcomes of pregnancy.