子宫内膜各层及浅肌层中雌孕激素受体的表达

发布时间：2018-08-12 20:45

【摘要】：背景与目的雌激素受体（ER）与孕激素受体（PR）是一种蛋白质分子核受体，靶器官的细胞内是它们主要的表达场所，可与相应的激素结合而发生特异性的反应进而形成激素-受体复合物，使激素发挥其生物学效应进而引起子宫内膜等的生长。有研究表明，当ER与PR含量不足或功能异常时，可影响子宫内膜的生长。子宫内膜损伤性疾病如宫腔粘连(intrauterine adhesion，IUA)是因不恰当的宫腔操作引起的严重困扰孕龄妇女的疾病，其发病率居高不下，子宫内膜因宫腔操作的损伤而没及时恢复引发的子宫壁创面相互粘连，使宫腔失去正常形态。月经异常、继发不孕是宫腔粘连引起的最困扰患者的两大症状。宫腔镜下粘连分离术(transccrvical resectionofadhesions，TCRA)因其是在可视下对宫腔粘连带进行分离，不仅更有目的性，而且也减少了因盲目分离形成的不必要的创伤。近年对宫腔粘连的研究又发现新的问题：中重度宫腔粘连分离术后，患者宫腔又形成新的粘连带，导致手术失败。于是宫腔粘连分离术后再粘连的预防至今还是临床治疗中的难题，，也是研究的热点。预防宫腔粘连术后再粘连是宫腔粘连术后综合治疗的重要措施之一，很多专家经验性用雌孕激素周期模仿正常人的激素改变来刺激残余的子宫内膜生长并使术后创面重新上皮化，以达到预防宫腔粘连分离术后粘连的再次复发。不同程度的宫腔粘连，可伤及子宫内膜的功能层、基底层或浅肌层，但对子宫内膜功能层、肌底层浅肌层(紧挨着肌底层的肌层)雌孕激素受体的分布情况的研究国内外鲜有报道。本实验通过对子宫内膜功能层、肌底层及浅肌层中雌孕激素受体的分布情况，试图为中重度宫腔粘连分离术雌孕激素的应用提供理论依据。材料与方法 1标本选择选取从2000～2012年郑州大学第三附属医院住院部因宫颈不典型增生、宫颈癌、卵巢癌、子宫脱垂行子宫全切的患者30例，年龄27～45岁，平均38.5±0.5岁。所选患者均符合以下标准：月经规律、半年内未服用任何激素类药物、正常子宫(无子宫肌瘤、子宫腺肌症、子宫内膜息肉等)、所选标本为月经中后期子宫内膜(平均第17.5±0.5天)。 2常规石蜡包埋，切片厚4um，以备免疫组化检测用。在显微镜下根据功能层、肌底层、浅肌层各自的组织学特点进行组织学分层。 3ER、PR的检测：三组标本均采用免疫组化SP法染色，功能层、肌底层、浅肌层互为对照组。严格依照试剂要求的步骤进行操作，ER、PR在细胞核内定为最多，阳性结果是：胞核为棕红色或是棕黄色，其组织结构及背景清晰；阴性结果是：不着色。随机选取每张切片的10个高倍镜视野，然后在光镜下观察，计数视野中的阳性细胞。取平均值计百分数。根据阳性细胞的百分率进行分析：(-)阳性细胞小于10%，(+)阳性细胞10%-29%，(++)30%～49%，(+++)大于等于50%。结果 1ER与PR的分布在子宫内膜功能层(30例/30例)，肌底层(30例/30例)，浅肌层中(30例/30例)。结果表明：ER与PR在子宫内膜功能层、肌底层及浅肌层的分布无明显统计学意义(P0.05)。 2ER在子宫内膜功能层、肌底层及浅肌层的表达水平依次降低，组间差异有统计学意义(P0.001)。 3PR在子宫内膜功能层、肌底层及浅肌层的表达水平依次降低，组间差异有统计学意义(P0.001)。结论 ER、PR在子宫内膜功能层、肌底层及浅肌层中的表达水平依次降低，可指导伤及不同层次子宫内膜的中重度宫腔粘连分离术后雌孕激素的用药。
[Abstract]:Background and purpose
Estrogen receptor (ER) and progesterone receptor (PR) are protein molecule nuclear receptors. Target organs are the main expression sites of ER and PR. They can react specifically with the corresponding hormones to form hormone-receptor complexes, which enable hormones to exert their biological effects and induce endometrial growth. Endometrial injury, such as intrauterine adhesion (IUA), is a serious disorder of pregnant women caused by inappropriate uterine manipulation. The incidence of the disease remains high and the endometrium does not recover promptly due to the injury of uterine manipulation. Abnormal menstruation and secondary infertility are two of the most disturbing symptoms of uterine adhesion. hysteroscopic adhesion separation (TCRA) is not only more purposeful but also less effective because it can separate the adhesions in uterine cavity visually. Recent studies on intrauterine adhesions have found new problems: after the separation of moderate and severe intrauterine adhesions, new adhesions are formed in the uterine cavity of the patients, leading to the failure of the operation. Prevention of intrauterine adhesions is one of the important measures of comprehensive treatment after intrauterine adhesions surgery. Many experts empirically use estrogen and progesterone cycles to stimulate the growth of residual endometrium and re-epithelialize the wound after operation to prevent the recurrence of intrauterine adhesions after separation. Degree of intrauterine adhesions can injure the functional layer, basal layer or superficial muscle layer of endometrium, but there are few reports about the distribution of estrogen and progesterone receptors in the functional layer of endometrium and superficial muscle layer of the myometrium. The distribution of estrogen and progesterone in patients with moderate to severe intrauterine adhesions was studied.
Materials and methods
1 Specimens were selected from 2000 to 2012 in the Third Affiliated Hospital of Zhengzhou University. Thirty patients with atypical cervical hyperplasia, cervical cancer, ovarian cancer and uterine prolapse underwent total hysterectomy, aged 27-45 years, with an average age of 38.5 + 0.5 years. (No hysteromyoma, adenomyosis, endometrial polyps, etc.), the selected specimens were endometrium in the middle and late period of menstruation (average 17.5 (+ 0.5 days).
2 Routine paraffin embedding and 4 um thick section for immunohistochemical detection. Histological stratification was performed under microscope according to the histological characteristics of functional layer, muscular bottom layer and superficial muscle layer.
Detection of ER and PR: All the three groups were stained by immunohistochemical SP method. Functional layer, muscular bottom layer and superficial muscle layer were the control group. 10 high power microscopic views were randomly selected from each slice, and then observed under light microscope to count the positive cells in the field. The average percentage was calculated. According to the percentage of positive cells, the results showed that (-) the positive cells were less than 10%, (+) the positive cells were 10%-29%, (++) 30%-49%, (+++++) more than 50%.
Result
The results showed that the distribution of ER and PR in the functional layer of endometrium (30 cases/30 cases), the basal layer of myometrium (30 cases/30 cases), and the superficial layer of myometrium (30 cases/30 cases).
The expression level of 2ER in endometrial functional layer, myometrial floor and superficial myometrium decreased in turn, and the difference was statistically significant (P 0.001).
The expression level of 3PR in endometrial functional layer, myometrial basal layer and superficial layer decreased in turn, and the difference was statistically significant (P 0.001).
conclusion
The expression of ER and PR in the functional layer of endometrium, the basal layer of myometrium and the superficial layer of myometrium decreased in turn, which could guide the administration of estrogen and progesterone after the separation of moderate and severe intrauterine adhesions.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.74

【参考文献】