左炔诺孕酮宫内缓释系统对增生过长子宫内膜IGF-Ⅰ和IGF-Ⅱ及其受体表达的影响

目的:探讨左炔诺孕酮宫内缓释系统(LNG-IUS)对增生过长子宫内膜胰岛素样生长因子-Ⅰ(IGF-Ⅰ)和胰岛素样生长因子-Ⅱ(IGF-Ⅱ)及其相应受体(IGF-IR,IGF-ⅡR)表达的影响。方法:应用免疫组化链霉亲和素-生物素-过氧化物酶复合物(SABC)方法,分别检测子宫内膜增生过长患者子宫内置入LNG-IUS(LNG-IUS组)及炔诺酮(炔诺酮组)治疗前后子宫内膜腺上皮细胞及间质细胞中IGF-Ⅰ和IGF-Ⅱ及其相应受体的表达,并与正常增生期、分泌期子宫内膜中相关因子表达作比较。结果:宫内置入LNG-IUS3个月后,IGF-Ⅰ表达下降,IGF-Ⅱ的表达上升,与治疗前比较有统计学意义(P<0.05)。LNG-IUS组子宫内膜IGF-Ⅰ表达明显低于炔诺酮组,两者比较有统计学意义(P<0.05);IGF-Ⅱ在LNG-IUS治疗后的子宫内膜的表达高于炔诺酮治疗后的子宫内膜,但无统计学意义。LNG-IUS治疗前后IGF-IR表达无显著性变化,各组之间的比较无统计学意义(P>0.05)。宫内置入LNG-IUS3个月后,IGF-IIR表达增强,治疗前后比较差异有统计学意义(P<0.05)。结论:LNG-IUS通过抑制增生过长子宫内膜IGF-Ⅰ表达,上调IGF-Ⅱ表达,抑制雌激素对子宫内膜的增生效应。LNG-IUS对子宫内膜IGF系统的调节作用较口服炔诺酮显著。子宫内膜增生过长宫腔内置入LNG-IUS后子宫内膜IGF系统的表达与增生期、分泌期子宫内膜均不相同,呈现一种极弱IGF-Ⅰ的表达和强IGF-Ⅱ表达类型。

The Effectiveness of the Levonorgestrel - Releasing Intrauterine System on the Insulin - like Growth Factor - Ⅰ and Insulin - like Growth Factor - Ⅱ and Their Receptors of Endometria Hyperplasia

Objective:To study the effect of the levonorgestrel-releasing intrauterine system (LNG-IUS) on the insulin-like growth factor-Ⅰ(IGF-Ⅰ) and isulin-like growth factor-Ⅱ(IGF-Ⅱ) and their receptors of endometria hyperplasia. Methods: The expressions of the IGF-I, IGF-Ⅱ and their receptors were detected by immunohistochemistry method in the 20 patients suffered with endometrial hyperplasia who were divided into LNG-IUS group(treated with LNG-IUS) and norethisterone group(treated with norethisterone), and pretreatment and posttreatment endometria were compared with proliferative phase and of secretory phase endometria. Results: After three months' treatment, the expression of IGF-I was down-regulated and IGF-Ⅱ was up-regulated in the LNG-exposed endometria compared with pretreatment endometria(P<0.05). The expression of IGF-I in the endometria treated with LNG-IUS was significantly lower than that treated with northisterene(P<0.05). The expression of IGF-Ⅱ was higher in the endometria treated with LNG-IUS than in that treated with northisterene though the statistics analysis was not significantly different(P>0.05) . The expression of IGF-IR showed no significant difference whether before or after LNG-exposed, and it showed no significant difference among all groups, either(P>0.05). After treated with LNG-IUS for 3 months, the expression of insulin-like growth factor I receptor(IGF-IR) was increased (P<0.05), which was higher than the northisterone control group(P<0.05). Conclusion: It shows stronger expression of IGF-II with suppression of IGF-Ⅰ in endometria, and inhibition of the proliferous effect of estrogen on endometria exposed to LNG are showed. LNG-IUS appears stronger effect on the expression of IGFs of endometria than those of northisterone. The expression of IGFs exposed to LNG-IUS in endometria is different from that of in the proliferative phase and of secretory phase endometria, which shows stronger expression of IGF-Ⅱ and weaker expression of IGF-Ⅰ.