ER、PR、Ki-67、MMP-9在绝经后子宫内膜息肉中的表达

发布时间：2018-01-24 10:05

  本文关键词： 绝经后 内膜息肉 ER PR Ki-67 MMP-9　出处：《大连医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：子宫内膜息肉是比较常见的妇科瘤样病变，可发生在任何年龄，多在40-60岁，发病率国外文献报道为7.8%-34.9%。与绝经前的子宫内膜息肉相比，绝经后子宫内膜息肉癌前病变及恶变率可高达4.1%。由于诱发子宫内膜息肉的原因较多，发病机制不十分清楚，一般认为该病与炎症反应及体内雌激素、孕激素的刺激和雌激素、孕激素受体水平、细胞增殖与凋亡机制有着密切关系。本研究意在通过观察绝经后子宫内膜息肉中ER、PR、MMP-9、Ki-67的表达情况，欲探讨子宫内膜息肉的相关发病机制，并寻找预测绝经后子宫内膜息肉恶变可能的相关蛋白，从而指导治疗及判断预后。 方法：实验中所选取的病例标本来自我院2013年1月1日至2013年12月31日期间的手术患者，所有患者均无体重标准为肥胖情况，无高血压病、糖尿病病史，未服用过三苯氧胺类药物、非甾体抗炎药，无经历雌孕激素替代治疗病史及患其他恶性肿瘤病史。其中经手术切取的绝经后子宫内膜标本18例，经宫腔镜下摘除或宫腔镜手术切除的绝经后子宫内膜息肉标本30例。本实验分为两组，绝经后子宫内膜组为对照组，选取条件为平素身体健康，自然绝经后超1年因子宫脱垂行阴式全子宫切除术，，术前超声提示子宫萎缩，内膜厚5mm，术中剖视大体标本，见内膜光滑，萎缩，经病理证实为正常绝经后内膜；绝经后子宫内膜息肉组为实验组，选取条件为平素身体健康，自然绝经后超1年因阴道排液、流血、下腹痛、常规体检超声提示内膜厚≥5mm，回声欠均匀，进一步宫腔镜检查提示子宫内膜息肉，行宫腔镜下内膜息肉摘除术或宫腔镜下内膜息肉切除术，经病理证实为子宫内膜息肉，且排除其他内膜病变。实验采用免疫组化法，检测两组中ER、PR、Ki一67、MMP-9在组织中的表达情况。取半定量评分方法，分析两组中腺体及间质细胞中阳性细胞的平均百分数进行评估。 结果：实验组与对照组中ER的表达阳性率分别为93％和78％，ER蛋白在实验组强阳性表达情况高于对照组；实验组与对照组中PR的表达阳性率分别为87％和67％，PR蛋白在实验组强阳性表达情况高于对照组；实验组与对照组中Ki一67的表达阳性率分别为53％和33％，Ki-67的阳性表达呈现弱阳性，且实验组阳性表达情况高于对照组；实验组与对照组中MMP-9的表达阳性率分别为33％和11％，MMP-9的阳性表达呈现弱阳性，且实验组阳性表达情况高于对照组。 结论：1）.ER、PR含量升高是促使绝经后子宫内膜息肉的发生；2）.Ki-67、MMP-9的表达参与了绝经后子宫内膜息肉的生成；3）.绝经后子宫内膜息肉中Ki一67、MMP-9的表达不能作为子宫内膜息肉向子宫内膜癌发展的预测指标。
[Abstract]:Objective: endometrial polyps are common gynecologic tumor-like lesions, which can occur at any age, mostly in 40-60 years old. The incidence rate of endometrial polyps was reported as 7.8- 34.9. compared with premenopausal endometrial polyps. The rate of precancerous lesion and malignant change of endometrial polyps after menopause can be as high as 4.1. Because there are many reasons to induce endometrial polyps, the pathogenesis of endometrial polyps is not very clear. It is generally believed that the disease is associated with inflammatory reaction and estrogen in vivo. Progesterone stimulation is closely related to estrogen, progesterone receptor, cell proliferation and apoptosis mechanism. This study was designed to observe ERP PR-MMP-9 in postmenopausal endometrial polyps. To explore the pathogenesis of endometrial polyps and to find the related proteins to predict the malignant change of postmenopausal endometrial polyps, the expression of Ki-67 could guide the treatment and judge the prognosis of endometrial polyps. Methods: all the patients were selected from our hospital from January 1st 2013 to December 31st 2013. All the patients had no obesity and no hypertension. There were no history of diabetes, no tamoxifen, no steroidal anti-inflammatory drugs, no history of estrogen and progesterone replacement therapy and other malignant tumors. 18 cases of postmenopausal endometrial specimens were surgically removed. Thirty cases of postmenopausal endometrial polyps were removed by hysteroscopy or hysteroscopic surgery. This experiment was divided into two groups: the postmenopausal endometrium group was the control group, and the condition was normal body health. Vaginal hysterectomy due to uterine prolapse was performed more than 1 year after natural menopause. Preoperative ultrasound revealed uterine atrophy and endometrial thickness of 5 mm. Normal postmenopausal intima was confirmed by pathology. The group of postmenopausal endometrial polyps as the experimental group, select the condition of normal physical health, natural menopause more than one year due to vaginal effusion, bleeding, lower abdominal pain, the conventional ultrasound showed that the thickness of the endometrium 鈮

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