症状性子宫肌瘤子宫内膜中COX-2、VEGF和微血管密度的表达

目的:探讨症状性子宫肌瘤患者子宫内膜中COX-2、VEGF和微血管密度的表达,及其与子宫肌瘤异常子宫出血的相关性。方法:选择病理证实为单纯子宫肌瘤的标本53例,根据子宫肌瘤患者有无月经改变症状分为A、B两组,以月经正常的健康妇女子宫内膜作为正常对照(C组),各组再根据子宫内膜病理类型进行组内分型,采用免疫组化技术对3组子宫内膜中COX-2、VEGE、MVD水平进行检测。结果:①VEGF、COX-2在各组子宫内膜中的表达:VEGF、COX-2在A组子宫内膜增生期、分泌期中的表达水平高于B、C两组同型子宫内膜,差异有统计学意义(P<0.05);在A组单纯性增生过长和复杂性增生过长子宫内膜中的表达水平显著低于A、B、C 3组增生期内膜,差异有统计学意义(P<0.001);在B组与C组同型子宫内膜中的表达水平比较差异无统计学意义(P>0.05)。A、B、C 3组增生期COX-2、VEGF表达水平与分泌期比较,差异均无统计学意义(P>0.05)。②MVD在各组子宫内膜中的表达:MVD在A组增生期和分泌期子宫内膜表达水平高于B、C两组同型子宫内膜,差异有统计学意义(P<0.05);在A组单纯性增生过长和复杂性增生过长内膜中的表达水平近似但又低于A、B、C 3组增生期子宫内膜,差异有统计学意义(P<0.001);在B组与C组同型子宫内膜中的表达水平比较差异无统计学意义(P>0.05);在A、B、C 3组增生期内膜与分泌期子宫内膜中的表达水平比较差异无统计学意义(P>0.05)。③症状性子宫肌瘤患者子宫内膜中COX-2、VEGF和MVD表达水平的相关性:症状性子宫肌瘤患者子宫内膜中COX-2与VEGF表达水平均呈正相关(γ=0.779,P<0.05;γ=0.626,P<0.05;γ=0.666,P<0.01),且MVD表达水平与COX-2、VEGF表达水平呈正相关(γ=0.829,P<0.05;γ=0.798,P<0.05)。结论:症状性子宫肌瘤患者子宫内膜COX-2、VEGF和MVD的表达增强,特别是在单纯性增生过长和复杂性增生过长的子宫内膜中COX-2、VEGF、MVD水平均有显著的变化,但无症状性子宫肌瘤患者子宫内膜内环境无异常改变,故认为子宫内膜微环境的异常改变是子宫肌瘤患者产生异常子宫出血的原因,这一结论为临床症状性子宫肌瘤患者的保守治疗提供了可靠的理论依据。

Expression levels of cyclooxygenase-2,vascular endothelial growth factor and microvessel density in endometrium of patients with symptomatic uterine leiomyomas

Objective:To explore the expression levels of cyclooxygenase-2(COX-2),vascular endothelial growth factor(VEGF) and microvessel density(MVD) in endometrium of patients with symptomatic uterine leiomyomas,and the relationship between VEGF,COX-2 and MVD and abnormal bleeding of uterine leiomyomas.Methods:53 patients with uterine leiomyomas diagnosed by pathological examination were divided into two groups(group A and group B) based on the symptom of menorrhagia and healthy women with normal menstruation were recruited into group C.The three groups were divided into different subgroups according to pathological examination of endometrium.33 patients with symptomatic uterine leiomyomas in group A consisted of 13 patients with proliferative phase endometrium,11 patients with secretory phase endometrium,6 patients with simple hyperplasia and 3 patients with complex hyperplasia.20 patients with asymptomatic uterine leiomyomas were recruited into group B with 15 patients in proliferative phase and 11 patients in secretory phase.12 healthy women of group C consisted of 6 patients in proliferative phase and 6 patients in secretory phase.Immunohistochemistry was used to investigate the expression levels of COX-2,VEGF and MVD in endometrium of the three groups.Results:The expression levels of COX-2 and VEGF in endometrium of proliferative phase and secretory phase in group A were higher than those in group B and group C(P<0.05).The expression levels in endometrium of simple hyperplasia and complex hyperplasia phase were significantly lower than those in proliferative phase in each group(P<0.001).There was no significant difference in expression levels of COX-2 and VEGF between group B and group C in endometrium in proliferative phase or secretory phase(P>0.05).There was no significant difference in expression levels of COX-2 and VEGF in the three groups with endometrium in proliferative phase or secretory phase(P>0.05).The expression of MVD in endometrium of each group: the positive expression levels of CD34-marked MVD in endometrium of proliferative and secretory phase in group A were significantly higher than those in group B and group C(P<0.05).The expression levels in endometrium of simple hyperplasia and complex hyperplasia phase were similar but significantly lower than those in proliferative phase in each group(P<0.001).There was no significant difference in expression of MVD between group B and group C in endometrium in proliferative phase or secretory phase(P>0.05).Correlations between VEGF,COX-2 and MVD expression in group A: in all the subgroups,there was positive correlation between COX-2 and VEGF(γ=0.779,P<0.05;γ=0.626,P<0.05;γ=0.666,P<0.01).The expression of MVD was positively correlated with COX-2 and VEGF(γ=0.829,P<0.05;γ=0.798,P<0.05).Conclusion:There are increasing expression levels of COX-2,VEGF and MVD in endometrium of patients with symptomatic uterine leiomyomas,especially in hyperplasia endometrium,but no changes in endometrium of patients with asymptomatic uterine leiomyomas.Abnormal changes of endometrial microenvironment is responsible for menorrhagia of patients with uterine leiomyomas.