LNG-IUS对腺肌症子宫内膜VEGF、Ang-1、Ang-2的影响

目的研究子宫腺肌症患者放置左炔诺孕酮宫内缓释系统（LNG-IUS）后子宫内膜血管内皮生长因子（VEGF）、促血管生成素（Ang-1、Ang-2）表达的变化,从血管生成及血管稳定性方面探讨子宫腺肌症患者放置LNG-IUS后不规则出血的发生机制。方法收集41例放置LNG-IUS腺肌症患者的子宫内膜,应用免疫组化染色（DAKO EnvisionTM System法）检测其子宫内膜VEGF、Ang-1、Ang-2的表达水平,同时设立子宫腺肌症对照组（16例）。结果放置LNG-IUS后异常出血组（16例）子宫内膜VEGF、Ang-2表达较无异常出血组（25例）增高,差异有统计学意义（P〈0.05）;而Ang-1在异常出血组与无异常出血组子宫内膜的表达差异无统计学意义（P〉0.05）。根据LNG-IUS放置年限不同,将放置LNG-IUS的患者分为放置1年内组、放置1～2年组、放置2年以上组。放置1～2年组、放置2年以上组子宫内膜VEGF、Ang-2表达比放置1年内组低,差异有统计学意义（P〈0.05）。Ang-1在不同放置年限组间差异均无统计学意义（P〉0.05）。结论 VEGF、Ang-1、Ang-2可能通过影响微血管生成及血管稳定性参与LNG-IUS的出血副反应。

The influence of levonorgestrel intrauterine system on endometrial VEGF/Ang-1/Ang-2 of women with adenomyosis

Objective To determine the alteration of endometrial VEGF/Ang-1/Ang-2 expression of women with adenomyosis after using levonogestrel intrauterine system,and elucidate the possible mechanism of breakthrough bleeding in the use of LNG-IUS on angiogenesis and vascular stability.Methods Endometrial biopsies was obtained from 41 women with adenomyosis undergoing treatment with LNG-IUS by using Pipelle suction curette,determine the endometrial VEGF/Ang-1/Ang-2 expression through immunohistochemistry.We also took the endometrial tissue from patients diagnosed as adenomyosis without any treatment as control groups.Results The LNG-IUS group was divided into bleeding group （16 cases） and non-bleeding group （25 cases）,according to the bleeding patterns in the last 3 months before biopsy.The staining for VEGF/Ang-2 in bleeding group was significantly higher than that in nonbleeding group （P＆lt;0.05）.The Ang-1 staining in glandular epithelium and stromal cells between two groups was not significant different （P＆gt;0.05）.Divided the LNG-IUS group into the less than 1-year group,1-2 year group and more than 2-year group,we had found that the 1-2 year group and the more than 1-year group exhibited significantly lower immunoreactivity for VEGF and Ang-2 in both glandular epithelium and stromal cells （P＆lt;0.05）,while there were no significant differences in immunoreactivity for the Ang-1 among different groups （P＆gt;0.05）.Conclusion VEGF and Ang1,Ang-2 may play a role in provoking breakthrough bleeding in the use of LNG-IUS by influencing angiogenesis and vascular stability.