上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (10): 1413-.doi: 10.3969/j.issn.1674-8115.2011.10.012

• 论著（临床研究） • 上一篇    下一篇

异位子宫内膜17β-羟基类固醇脱氢酶2缺乏与孕激素受体亚型变化的相关性研究

张 萍1, 李笛悠1, 惠 宁2   

  1. 1.上海交通大学 医学院附属新华医院妇科, 上海 200092； 2.第二军医大学附属长海医院妇产科, 上海 200433
  • 出版日期:2011-10-28 发布日期:2011-10-27
  • 通讯作者: 惠 宁, 电子信箱: hun1956@yahoo.com.cn。
  • 作者简介:张 萍（1962—）, 女, 主任医师, 硕士；电子信箱: zjqzp@126.com。

Relationship between 17β-hydroxysteroid dehydrogenase 2 deficiency and changes of progesterone receptor isoforms in ectopic endometrium

ZHANG Ping1, LI Di-you1, HUI Ning2   

  1. 1.Department of Gynecology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China；2.Department of Obstetrics and Gynecology, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
  • Online:2011-10-28 Published:2011-10-27

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摘要：

目的 探讨子宫内膜异位症(EMT)病灶对孕激素不敏感是否由局部孕激素受体（PRs）亚型及17β-羟基类固醇脱氢酶2（17β-HSD2）改变或功能缺陷所致。方法 采用Real-Time PCR检测36例EMT患者的卵巢异位子宫内膜(EMT异位子宫内膜组)和16例在位子宫内膜(EMT在位子宫内膜组)的PR-(A+B)、PR-A、PR-B及17β-HSD2 mRNA的表达；免疫组织化学方法检测PR-(A+B)、PR-B和17β-HSD2蛋白的表达。结果 EMT在位子宫内膜组PR-(A+B)、PR-B、PR-A mRNA增殖期较分泌期表达升高（P＜0.05）；增殖期子宫内膜腺上皮细胞及间质细胞都有PRs表达，在分泌期主要在间质细胞中表达；PR-A占优势，PR-A/PR-B比值在整个月经周期中保持相对恒定。子宫内膜间质细胞中PR-B与腺上皮细胞中17β-HSD2的表达一致。EMT异位子宫内膜组PR-A在整个月经周期中持续性低表达，在分泌期与在位内膜PR-A表达差异无统计学意义（P＞0.05）；PR-B在整个月经周期的表达明显低于在位内膜；PR-A及PR-B的周期性变化消失。与EMT在位子宫内膜组比较，EMT异位子宫内膜组PR-B表达相对降低，PR-A／PR-B值显著升高（P=0.001）。EMT异位子宫内膜组间质细胞中PR-B明显下降；17β-HSD2也明显下降，其周期性变化消失。结论 异位子宫内膜的PRs亚型改变影响17β-HSD2的表达，可能是EMT发生孕激素抵抗的分子机制之一。

关键词: 子宫内膜异位症, 异位子宫内膜, 孕激素受体亚型, 17β-羟基类固醇脱氢酶2, 孕激素抵抗

Abstract:

Objective To investigate the mechanism of changes of isoforms of local progesterone receptors (PRs) and 17β-hydroxysteroid dehydrogenase 2 (17β-HSD2) deficiency in insensitiveness of ectopic endometrium (EMT) to progestin. Methods Ectopic endometrium samples of 36 cases of EMT (EMT ectopic endometrium group) and 16 samples of eutopic endometrium (EMT eutopic endometrium group) were selected, the expression of PR-(A+B), PR-A, PR-B and 17β-HSD2 mRNA was detected by Real-Time PCR, and the expression of PR-(A+B), PR-B and 17β-HSD2 protein was determined by immunohistochemistry. Results In EMT eutopic endometrium group, the expression of PR-(A+B), PR-B and PR-A mRNA in proliferative phase was significantly higher than that in secretory phase (P＜0.05). PRs were expressed in both endometrial epithelial and stromal cells in proliferative phase, while those were mainly expressed in stromal cells in secretory phase. PR-A gained the advantage between PR-A and PR-B, while the rate of PR-A/PR-B was relatively stable during the whole menstrual cycle. The expression of PR-B in endometrial stromal cells was positively correlated with that of 17β-HSD2 in epithelial cells. In EMT ectopic endometrium group, the expression of PR-A was continuously low in the whole menstrual cycle, while there was no significant difference between the expression of PR-A in ectopic endometrium and that in eutopic endometrium in secretory phase (P＞0.05). The expression of PR-B in ectopic endometrium was significantly lower than that in eutopic endometrium in the whole menstrual cycle, and the cyclical variations of PR-A and PR-B disappeared in ectopic endometrium. Compared with EMT eutopic endometrium group, the expression of PR-B in EMT ectopic endometrium group was significantly lower, and the rate of PR-A/PR-B was significantly higher （P=0.001）. In EMT ectopic endometrium group, PR-B was significantly lower in stromal cells, 17β-HSD2 also decreased significantly, and the cyclical variation of 17β-HSD2 disappeared. Conclusion The changes of isoforms of PRs in ectopic endometrium may influence the expression of 17β-HSD2, which may be one of the mechanisms of progestin resistance for EMT.

Key words: endometriosis, ectopic endometrium, progesterone receptor isoforms, 17β-hydroxysteroid dehydrogenase 2, progestin resistance