无排卵性功能失调性子宫出血患者子宫内膜雌、孕激素受体及基质金属蛋白酶表达变化的研究

目的研究无排卵性功能失调性子宫出血(功血)患者子宫内膜雌激素受体(ER)、孕激素受体(PR)、IV型胶原、基质金属蛋白酶-9(MMP-9)及其抑制物-1(TIMP-1)的表达,探讨无排卵性功血的发病机制。方法采用免疫组化法检测20例正常增殖期子宫内膜(对照组)和66例无排卵性功血患者(病例组)子宫内膜腺上皮和基质细胞ER、PR、IV型胶原、MMP-9及TIMP-1表达。结果病例组子宫内膜腺上皮和基质ER、PR表达高于对照组(P<0.05),MMP-9水平明显增加(P<0.05),MMP-9/TIMP-1比值升高(P<0.01),IV型胶原含量明显下降(P<0.01)。相关分析显示,无排卵性功血患者子宫内膜MMP-9水平与ER、PR均呈正相关(r=0.605,P<0.05;r=0.697,P<0.05)。结论无排卵性功血患者子宫内膜出血原因可能与雌激素作用下ER、PR表达失调有关,且MMP-9水平异常升高,导致细胞外基质过度降解,临床表现为子宫不规则出血。

Expression of estrogen and progesterone receptor and matrix metalloproteinases in the endometrium of patients with anovulatory dysfunctional uterine bleeding

Objective: To investigate the expression of estrogen receptor(ER),progesterone receptor(PR),(collagen) IV and matrix metalloproteinase(MMPs) in the endometrium of patients with anovulatory(dysfunctional) uterine bleeding(DUB).Methods: Immunochemical SP technique was used to determine the expression of ER,PR,collagen IV,MMP-9 and TIMP-1 in the endometrium of 20 patients with normal menstrual cycle and 66 with(anovulatory) DUB.Results: Expression of ER and PR was significantly higher in the DUB endometrium with simplex and complex hyperplasia in comparison with the normal proliferative endometrium(P<0.05).MMP-9(immunoreactivity) in glandular epithelial cells and MMP-9/ TIMP-1 ratio were significantly higher in DUB endometrium with simplex and complex hyperplasia than those in the normal proliferative endometrium((P<0.01),) while expression of collagen IV was significantly lower in the endometrial stroma of DUB(patients.) MMP-9 was positively correlated with ER(r=0.605,P<0.05) and PR(r=0.697,P<0.05). Conclusions: The abnormal bleeding in DUB patients with simplex and complex endometrium hyperplasia might be associated with the abnormal expression of endometrial ER and PR,and with(up-regulation) of activity of MMP-9 in the endometrium which causes over-degradation of the ECM.