【摘要】：背景與目的 雌激素受體（ER）與孕激素受體（PR）是一種蛋白質(zhì)分子核受體，靶器官的細(xì)胞內(nèi)是它們主要的表達(dá)場所，可與相應(yīng)的激素結(jié)合而發(fā)生特異性的反應(yīng)進(jìn)而形成激素-受體復(fù)合物，使激素發(fā)揮其生物學(xué)效應(yīng)進(jìn)而引起子宮內(nèi)膜等的生長。有研究表明，當(dāng)ER與PR含量不足或功能異常時，可影響子宮內(nèi)膜的生長。子宮內(nèi)膜損傷性疾病如宮腔粘連(intrauterine adhesion，IUA)是因不恰當(dāng)?shù)膶m腔操作引起的嚴(yán)重困擾孕齡婦女的疾病，其發(fā)病率居高不下，子宮內(nèi)膜因?qū)m腔操作的損傷而沒及時恢復(fù)引發(fā)的子宮壁創(chuàng)面相互粘連，使宮腔失去正常形態(tài)。月經(jīng)異常、繼發(fā)不孕是宮腔粘連引起的最困擾患者的兩大癥狀。宮腔鏡下粘連分離術(shù)(transccrvical resectionofadhesions，TCRA)因其是在可視下對宮腔粘連帶進(jìn)行分離，不僅更有目的性，而且也減少了因盲目分離形成的不必要的創(chuàng)傷。近年對宮腔粘連的研究又發(fā)現(xiàn)新的問題：中重度宮腔粘連分離術(shù)后，患者宮腔又形成新的粘連帶，導(dǎo)致手術(shù)失敗。于是宮腔粘連分離術(shù)后再粘連的預(yù)防至今還是臨床治療中的難題，，也是研究的熱點(diǎn)。預(yù)防宮腔粘連術(shù)后再粘連是宮腔粘連術(shù)后綜合治療的重要措施之一，很多專家經(jīng)驗性用雌孕激素周期模仿正常人的激素改變來刺激殘余的子宮內(nèi)膜生長并使術(shù)后創(chuàng)面重新上皮化，以達(dá)到預(yù)防宮腔粘連分離術(shù)后粘連的再次復(fù)發(fā)。不同程度的宮腔粘連，可傷及子宮內(nèi)膜的功能層、基底層或淺肌層，但對子宮內(nèi)膜功能層、肌底層淺肌層(緊挨著肌底層的肌層)雌孕激素受體的分布情況的研究國內(nèi)外鮮有報道。本實(shí)驗通過對子宮內(nèi)膜功能層、肌底層及淺肌層中雌孕激素受體的分布情況，試圖為中重度宮腔粘連分離術(shù)雌孕激素的應(yīng)用提供理論依據(jù)。 材料與方法 1標(biāo)本選擇選取從2000～2012年鄭州大學(xué)第三附屬醫(yī)院住院部因?qū)m頸不典型增生、宮頸癌、卵巢癌、子宮脫垂行子宮全切的患者30例，年齡27～45歲，平均38.5±0.5歲。所選患者均符合以下標(biāo)準(zhǔn)：月經(jīng)規(guī)律、半年內(nèi)未服用任何激素類藥物、正常子宮(無子宮肌瘤、子宮腺肌癥、子宮內(nèi)膜息肉等)、所選標(biāo)本為月經(jīng)中后期子宮內(nèi)膜(平均第17.5±0.5天)。 2常規(guī)石蠟包埋，切片厚4um，以備免疫組化檢測用。在顯微鏡下根據(jù)功能層、肌底層、淺肌層各自的組織學(xué)特點(diǎn)進(jìn)行組織學(xué)分層。 3ER、PR的檢測：三組標(biāo)本均采用免疫組化SP法染色，功能層、肌底層、淺肌層互為對照組。嚴(yán)格依照試劑要求的步驟進(jìn)行操作，ER、PR在細(xì)胞核內(nèi)定為最多，陽性結(jié)果是：胞核為棕紅色或是棕黃色，其組織結(jié)構(gòu)及背景清晰；陰性結(jié)果是：不著色。隨機(jī)選取每張切片的10個高倍鏡視野，然后在光鏡下觀察，計數(shù)視野中的陽性細(xì)胞。取平均值計百分?jǐn)?shù)。根據(jù)陽性細(xì)胞的百分率進(jìn)行分析：(-)陽性細(xì)胞小于10%，(+)陽性細(xì)胞10%-29%，(++)30%～49%，(+++)大于等于50%。 結(jié)果 1ER與PR的分布在子宮內(nèi)膜功能層(30例/30例)，肌底層(30例/30例)，淺肌層中(30例/30例)。結(jié)果表明：ER與PR在子宮內(nèi)膜功能層、肌底層及淺肌層的分布無明顯統(tǒng)計學(xué)意義(P0.05)。 2ER在子宮內(nèi)膜功能層、肌底層及淺肌層的表達(dá)水平依次降低，組間差異有統(tǒng)計學(xué)意義(P0.001)。 3PR在子宮內(nèi)膜功能層、肌底層及淺肌層的表達(dá)水平依次降低，組間差異有統(tǒng)計學(xué)意義(P0.001)。 結(jié)論 ER、PR在子宮內(nèi)膜功能層、肌底層及淺肌層中的表達(dá)水平依次降低，可指導(dǎo)傷及不同層次子宮內(nèi)膜的中重度宮腔粘連分離術(shù)后雌孕激素的用藥。
[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.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R711.74

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