【摘要】 目的探讨神经生长因子(NGF)、转化生长因子β1(TGF-β1)在子宫腺肌病(AM)子宫内膜组织中的表达及左炔诺孕酮宫内缓释系统(LNG-IUS,曼月乐)对其的影响。方法选择2014年2月至2015年10月在河北医科大学第二医院行子宫全切或病灶切除的AM患者62例,根据视觉模拟评分法(VAS)及LNG-IUS放置史分为痛经组33例、无痛经组16例及曼月乐组13例。选择同期因子宫肌瘤行全子宫切除的无慢性盆腔痛及痛经的患者13例作为对照组。取两组在位内膜及病灶,采用免疫组织化学SP法分别检测在位、异位内膜NGF和TGF-β1蛋白表达水平。结果痛经组内膜NGF和TGF-β1蛋白表达较无痛经组和对照组显著增加(均P<0.05),且重度、轻中度痛经者与无痛经者比较差异有统计学意义(均P<0.05);痛经组内膜NGF和TGF-β1蛋白表达与VAS评分存在显著正相关性;曼月乐组内膜NGF和TGF-β1蛋白表达较痛经组显著降低(均P<0.05)。结论 AM在位、异位内膜中NGF和TGF-β1通过协同高表达,共同参与痛经发生;LNG-IUS抑制AM在位、异位内膜NGF和TGF-β1蛋白表达上调,可能是LNGIUS缓解AM痛经机制之一。更多还原

【Abstract】 Objective To explore the possible involvement of NGF and TGF-β1 in dysmenorrhea associated with adenomyosis(AM) and molecular mechanism of LNG-IUS in relieving dysmenorrhea. Methods From Feb.2014 to Oct.2015,62 AM patients undergoing hysterectomy or adenomyomectomy in the Second Hospital of Hebei Medical University were enrolled in this study,who were classified into dysmenorrhea group,non-dysmenorrhea group and LNGIUS-treated group based on visual analogue scale(VAS)and LNG-IUS-treatment history.Another 13 cases of fibroid receiving total hysterectomy who were without chronic pelvic pain or dysmenorrhea were included as the control group.The expressions of NGF and TGF-β1 in the eutopic and ectopic endometrium of each group were examined by immunohistochemistry.Results The expressions of NGF and TGF-β1 in the endometrium of dysmenorrhea group were higher than non-dysmenorrhea and control group(P<0.05),the difference between severe pain patients and mild to moderate pain and painless patients were statistically significant(P<0.05).The expressions of NGF and TGF-β1 in the endometrium and VAS score had a significant positive correlation.The expressions of NGF and TGF-β1 in the endometrium in LNGIUS-treatment group were lower than dysmenorrhea group(P<0.05).Conclusion The upregulated expressions of NGF and TGF-β1 in the eutopic and ectopic endometrium are both involved in dysmenorrhea.The suppression of NGF and TGF-β1 by LNG-IUS is another possible mechanism of relieving pain in patients with adenomyosis.更多还原