雌孕激素受体在绝经期子宫内膜息肉中的表达及其对治疗方式的启示

目的 探讨绝经后妇女子宫内膜息肉的治疗方法.方法 绝经期子宫内膜息肉患者71例,均接受宫腔镜下经宫颈息肉切除术(TCRP)治疗,术后未应用其他治疗.术后病理均诊断为子宫内膜息肉.采用免疫组化法检测蜡块组织中的雌激素受体(ER)和孕激素受体(PR)的表达.判定标准:计数10个高倍镜(×400)视野下的有黄染颗粒细胞个数,0个为阴性,1%～10%为( ),11%～50%为( ),＞50%为( ).结果 ER和PR在患者子宫内膜中的表达水平均较低,有74.6%和70.4%的患者无ER和PR的表达.而在绝经期子宫内膜息肉中ER和PR的表达水平较高,表达率分别为77.5%和69.0%,与子宫内膜比较有显著性差异(P值分别为0.019和0.001).在4例曾经应用激素替代治疗的患者中,3例绝经时间＞5年,内膜中ER、PR均为阴性;另1例绝经2年,内膜中受体表达ER( ),PR( ),但无临床症状.结论 绝经后,ER和PR的表达水平在正常子宫内膜与子宫内膜息肉中不同,提示绝经期子宫内膜息肉的发生可能同时与雌、孕激素受体水平有关,治疗时可以考虑单纯手术去除病灶.

The expression of estrogen and progesterone receptors in the endometrial polyps in postmenopausal women and its effect on therapy

Objective To discuss the treatments of endometrial polyps in postmenopausal women. Methods Seventy-one postmenopausal women diagnosed as endometrial polyps by pathology were observed. All patients were treated only with TCRP (trance cervical resection of polyp). Immunohistochemical method was used to detect the expressions of both estrogen and progesterone receptors in paraffin sections. Results The expression of both estrogen and progesterone receptors was statistically lower in the tissue of menopausal endometrium than that of polyps (P=0.019, 0.001 respectively). Among the four patients who had undergone HRT therapy, three with menopause over 5 years had negative expression results in both receptors. The other patient who had no vaginal bleeding for 2 years had no clinical symptom, and the expression results for both receptors were ( ). Conclusions The different expression rates of estrogen and progesterone receptors in endometrium and polyp tissues, suggest that the incidence of endometrial polyps in postmenopausal women is associated with the level of estrogen receptors and progesterone receptors. TCRP is the only therapy needed.