育龄期功能失调性子宫出血患者子宫内膜组织中雌、孕激素及其受体的变化与意义

目的:研究育龄期功能失调性子宫出血患者子宫内膜组织中雌、孕激素及其受体的变化。方法:随机采集2005年8月至2006年11月北方学院附属第一医院妇产科门诊育龄期功血35例患者的静脉血及子宫内膜功能层组织为研究组,以20例月经正常健康女性排卵后期标本为对照组。(1)采用放免法测定研究组及对照组血清及子宫内膜组织中雌二醇(E2)、孕激素(P)的含量;(2)HE染色后对子宫内膜进行组织学诊断;(3)用TUNEL原位标记技术精确测定子宫内膜功能层细胞凋亡指数;(4)用免疫组化法检测子宫内膜中雌、孕激素受体(ER、PR)的表达。结果:育龄期功血患者以排卵型为主(30/35),其子宫内膜组织中E2含量高于对照组(P<0.05),而P含量低于对照组(排卵后期的子宫内膜),二者差异有统计学意义(P<0.05);两组血清中E2、P差异无统计学意义(P>0.05),但血清、子宫内膜中E2和P呈正相关(rE2=0.74,PE2<0.01;rP=0.65PP<0.01);育龄期功血患者子宫内膜中ER、PR表达及凋亡指数较对照组显著增高,差异有统计学意义(P<0.01)。结论:育龄期功血绝大多数可能系体内作用于子宫内膜的雌、孕激素产生的时间、数量及其受体比例失衡所致,细胞凋亡也参与了功血的发生。

Changes of estrogen and progesterone and their receptors in endometria of women with adult dysfunctional uterine bleeding

Objective:To study the sex hormones levels and the expressions of estrogen receptor(ER) and progesterone receptor(PR) in endometrial functionalis of women with adult dysfunctional uterine bleeding(DUB).Methods:The venous blood and endometrial functionalis samples were collected from 35 adult DUB cases and 20 healthy women with regular menstrual cycle as controls.The levels of E2,P in serum and endometrial tissue were assayed by immunoradiometry.Endometrium histology after hematoryline and eosin (HE) staining was performed to identify as proliferative phase or secretory phase.TUNEL technology was used to label in situ apoptotic cells to detect exactly apoptosis index in endometrium tissue.The expressions of ER,PR in endometrium were determined by immunohistochemistry.Results:The majority of adult dysfunctional uterine bleeding was ovulatory type.The mean E2 concentration of endometrial tissue was significantly higher in DUB patients than that in controls (P<0.05).The mean P concentration of endometrial tissue was significantly lower in DUB cases than that in controls (P<0.05),whereas the mean serum E2 or P concentrations between the two groups were not significant (both P>0.05).Serum E2,P levels were positively correlated with endometrium tissue E2,P(rE2 =0.74,PE2 <0.01;rP=0.65,PP<0.01).The expressions of ER,PR and cellular apoptosis index in DUB endometria were significantly higher than that in control group (P<0.01,respectively).Conclusions:Adult dysfunctional uterine bleeding is probably linked to sex hormone,amount and disorder ratio of sex hormone receptors in local endometria.Increased apoptosis may be a factor in the pathogenesis of DUB.