Norplant皮下埋植后子宫内膜形态和雌、孕激素受体含量的变化

目的探讨Ｎｏｒｐｌａｎｔ皮下埋植后子宫内膜形态和雌、孕激素受体（ＥＲ、ＰＲ）含量的变化与子宫异常出血的关系。方法应用免疫组化、ＷｅｓｔｅｒｎＢｌｏｔ和原位杂交技术结合计算机图像分析,观察１６例Ｎｏｒｐｌａｎｔ皮下埋植后和２３例正常周期的内膜的形态学改变、细胞增殖状态及ＥＲ、ＰＲ蛋白及其ｍＲＮＡ的表达。结果埋植Ｎｏｒｐｌａｎｔ后,内膜ＤＮＡ含量降低;螺旋动脉数量减少,腺体的构成比例降低;腺体构成比例与雌二醇（Ｅ２）水平呈正相关,与子宫异常出血呈负相关,与年龄和体重无相关性,随使用期延长,腺体构成比增加。埋植后,内膜ＥＲ含量低于月经周期各期水平,但ＰＲ含量相当于或高于月经周期最高水平。ＥＲ、ＰＲｍＲＮＡ表达减弱,以ＥＲｍＲＮＡ表达降低更明显。结论内膜腺体和螺旋动脉再生修复不良和ＥＲ、ＰＲ表达异常,可能是Ｎｏｒｐｌａｎｔ致子宫异常出血的病理学基础

The changes of sex steroid receptors and morphology in Norplant treated endometrium

OBJECTIVE: To study the relationship between the changes of sex steroid receptors as well as endometrial morphology and abnormal uterine bleeding induced by Norplant. METHODS: Immunohistochemistry, Western Blot, in situ hybridization and computer image analysis were employed to demonstrate the expression of estrone receptor(ER) progesterone receptor(PR) protein and mRNA as well as morphometric analysis of the endometrium in Norplant users. RESULTS: The content of DNA and the numbers of spiral arterioles decreased in Norplant treated endometrium. The percentage of glandular area in Norplant endometrium was much lower than that in cyclic endometrium. A statistically significant correlation was observed between the percentage of area of glands and abnormal uterine bleeding, as well as serum estrogen(E2) level, but E2 level had no direct relationship with the bleeding abnormality. As the time growing, the percentage of glandular area increased. Immunostaining and relative concentration of glandular and stromal ER in Norplant treated endometrium were significantly weaker and less than all the stage of cyclic endometrium. However, PR, especially stromal PR immunostaining was very intense, which was the same or more than that in all the stage of cyclic endometrium. In situ hybridization detected that the ER and PR mRNA was lower in Norplant treated endometrium than that in cyclic endometrium. The ER mRNA expression was more less abundant than PR mRNA expression. CONCLUSION: These results suggested that poor repair and regeneration of endometrium(especially glands and spiral arterioles) and abnormal expression of ER and PR may be related to pathogenesis of abnormal uterine bleeding induced by Norplant implant.