【作者】 张扬；

【导师】 丘彦；

【作者基本信息】 重庆医科大学 ， 妇产科学， 2003， 硕士

【摘要】 目的：观察排卵正常的妇女子宫内膜接受性标志物—胞饮突的形成情况；研究胞饮突的发育与雌、孕激素及其受体的关系；验证尿LH(luteinizing hormone，LH)用于预测着床窗时间的可靠性。 方法：①对27名妇女进行阴道B超结合检测尿LH监测排卵。②于尿LH+3～11天随机进行一次子宫内膜活检，标本一部分行扫描电镜观察胞饮突，另一部分采用免疫组化技术检测子宫内膜上雌、孕激素受体(ER、PR)的表达。③活检日静脉采血3ml，用磁性分离酶联免疫法检测血清雌、孕激素。 结果：①按扫描电镜下所见超微结构特点将子宫内膜分为胞饮突发育之前、发育中、成熟的和退化的胞饮突四个阶段；②正常排卵周期成熟胞饮突可出现在尿LH+5天(n=1)，LH+6天(n=2)，LH+7天(n=3)，LH+8天(n=3)，88.89％(8/9)为LH+6～8天；③胞饮突的发育与血清孕激素水平呈正相关关系(r=0.515，P＜0.01)；④胞饮突发育后，PR在腺上皮的表达明显下降，而在间质中的表达无明显变化；腺上皮PR水平与血清孕重庆医科大学硕士学位论文激素水平呈负相关(r=一0.550，P<0.01)，与胞饮突的发育有负相关关系(r==一0.793，P<0.01);⑤未发现胞饮突的发育与ER、雌激素水平有相关性。 结论:①胞饮突是一种比较精确和个体化的子宫内膜接受性标志物。孕激素水平升高与胞饮突发育和腺上皮孕激素受体水平下调同步，孕激素通过调节PR参与对胞饮突发育的调控。②分泌期PR在腺上皮和间质细胞中的表达变化不同步，提示PR有功能上的分离。③本组排卵正常妇女的胞饮突多在尿LH+6一LH+8天出现，检测尿LH可用于临床着床窗口的确定。更多还原

【Abstract】 Objective: To observe the formation of pinopodes in human endometrium in ovulation normality cycles and to investigate the relation between the development of endometrial pinopodes and the estrogen/progesterone and their receptors. To know the reliability of predicting implantation window by testing urine LH.Methods: (1) Twenty-seven women were followed for one cycle by vaginal ultrasonograms, and by testing urine samples for LH surge. (2)An endometrial biopsy sample was obtained randomly between days 3 to 11 after the LH surge and divided into two pieces, one for scanning electron microscopy and the other for immunohistochemistry. The biopsy samples were analyzed for expression of estrogen and progesterone receptors (ER, PR) by using immunohistochemical techniques. (3) Serum samples were obtained on the biopsy day and determined the concentrations of estradiol and progesterone by magnetic solid phase enzyme immunoassay. Receptor expression was compared with hormone levels and thedevelopmental stage of the pinopodes.Result(s): (1) Biopsy samples were grouped according to developmental stage of the endometrium as determined by scanning electron microscopy, which were defined as before pinopodes, developing pinopodes, fully developed pinopodes and regressing pinopodes. (2) Fully developed pinopodes were seen on days LH+5(n=1), LH+6(n=2), LH+7(n=3), LH+8(n=3).In 88.89% cases, fully developed pinopodes appeared on LH+6-LH+8. (3) The development of pinopodes was positively correlated with the progesterone level (r=0.515,P<0.01).(DThe expression of PR in stromal cells did not change during luteal period. PR in the glandular epithelial was greatly decreased when fully developed pinopodes formed. The expression of the PR in the glandular epithelial cells was negatively correlated with the progesterone level in serum (r=-0.550, P < 0.01 ) and it was negatively correlated with pinopodes developmental stage (r=-0.793, P < 0.01) . (5) Levels of estrogen receptors and serum estradiol did not correlate withpinopodes formation.Conclusion(s): (1)Pinopodes is a precise and individualized marker of implantation window. Progesterone regulated the expression of pinopodes by PR. The formation of pinopodes was concurrent with serum progesterone increasing and down-regulationof glandular epithelial progesterone receptors. (2)PR was found to change dyssynchronously in epithelium and stroma, which suggested segregation of function on the basis of receptor.(3)In 88.89% cases, pinopodes were observed at LH+6-LH+8, therefore, it may be possible to predict the implantation window by using LH surge.更多还原