异位子宫内膜孕激素受体亚型表达及局部孕激素抵抗.doc

异位子宫内膜孕激素受体亚型表达及局部孕激素抵抗 　 作者：曲军英, 欧湘红, 杨代兴, 张声, 林经安, 马炎辉 【关键词】 子宫内膜异位症;,孕激素；,孕激素酮 　　摘要: 目的 探讨卵巢子宫内膜异位症(EMS)病灶对生理状态的孕激素水平反应不良是否由局部孕激素受体亚型分布及数量改变或功能缺陷所致。方法 采用RTPCR技术和免疫组织化学方法,检测45例EMS患者的卵巢异位子宫内膜(卵巢EMS组)和在位内膜(在位内膜组)及35例其他患者的正常子宫内膜(对照组)的孕激素受体PR(A+B)、孕激素受体亚型A、B(PRA、PRB)mRNA及其蛋白的表达。 结果(1)对照组和在位内膜组的PR表达在增生期增强，并随分泌期逐渐减弱；PRA占优势，PRB/PRA比值在整个月经周期保持相对恒定。(2)卵巢EMS组PRA、PRB、PR(A+B)表达绝对低于对照组(Plt;0.01),无周期性变化。异位内膜腺上皮PRA表达呈绝对降低，而间质中PRB表达相对增高，PRA不占优势,PRB/PR(A+B)显著增高(Plt;0.01)。结论异位子宫内膜存在局部孕激素受体亚型数量和比值改变,可能是子宫内膜异位症孕激素抵抗现象的主要分子机制。 　　关键词: 子宫内膜异位症; 孕激素； 孕激素酮 　　ABSTRACT: Objective To study the expression and distribution of progesterone subtype receptors(PR) in ovarian endometriosis.Methods The levels of PR(A+B) were assessed by RTPCR and PR(A+B) protein were detected by immunohistochemical assay in 45 ovarian endometriosis and their eutopic endometrium and 35 normal endometrium during the same menstrual cycle. Results PR expression was gradually increased during proliferative phase in the normal endometrium and eutopic endometrium, but gradually decreased along with the secretary phase.PRA was dominant during the menstualmenstrual cycle.However, the ratio PRB/PRA was maintained relatively constant. Compared with the normal endometrium, the expression of PRB and PR(A＋B) mRNA were lower(Plt;0.01) in ovarian endometriosis and showed no periodic variation during the menstrual cycle. In endometriotic gland epithelial cells, PRA protein was decreased absolutely, whereas in the stroma cell PRB expression was relatively increased and the ratio PRB/PR(A+B) was very significantly higher than that in normal endometrium(Plt;0.01). Conclusion A wide variety of concentrations of the PRB/PRA ratios in the endometriotic tissue might be considered as one of the molecular mechanisms of the progesterone resistance in endometriosis. 　　KEY WORDS: endometriosis; progestin; progesterone 　　 　　 　　子宫内膜异位症(EMS)是一种雌激素依赖性疾病,已有研究发现,尽管EMS患者的血清孕激素浓度与正常妇女相同,但腹腔液中孕激素(P)的水平却是后者的3~4倍[1]。临床病理发现,异位腺上皮多数保持增生状态,黄体期分泌反应差甚至无反应[2]。