摘要
目的 通过检测无排卵性功能失调性子宫出血（dysfunctional uterine bleeding,DUB）患者经射频（radiofrequency,RF）热凝固子宫内膜治疗前与治疗后随访6～12个月时,子宫内膜病理学类型及生存素（survivin） 、雌激素受体（estradiol receptor,ER）和孕激素受体（progesterone receptor,PR）表达水平比较,探讨经射频热凝固子宫内膜治疗无排卵性功能失调性子宫出血远期效果和发病机制.方法 选择2003年6月至2008年12月在本院住院,接受射频热凝固子宫内膜治疗的76例无排卵性功能失调性子宫出血患者纳入研究组（n=76）.研究组射频热凝固子宫内膜治疗前,进行诊断性刮宫取内膜组织,行病理学诊断结果示,单纯性增生为32例、复杂性增生为28例、增生期样内膜为16例.研究组按照射频治疗采取方式不同,分为A式RF组（n=23）：采取全内膜凝固（A式凝固法）,B式RF组（n=53）：采取选择式凝固（B式凝固法）.将同期在本院住院,经药物治疗的无排卵性功能失调性子宫出血患者38例纳入对照组（n=38）.对照组药物治疗前,子宫内膜诊断性刮宫治疗病理学诊断结果示,单纯性增生为16例、复杂性增生为12例、增值期内膜为10例.研究组和对照组患者均排除其他妇科疾病和妇科肿瘤等,近1个月未接受激素类治疗（本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书）.两组患者年龄等比较,差异无显著意义（P＞0.05）.采用免疫组织化学法检测两组治疗前与治疗后随访6～12个月时,生存素、雌激素受体和孕激素受体表达水平.结果 ①对照组治疗前和治疗后随访6～12个月时,子宫内膜诊断性刮宫病理学类型比较,经χ2检验显示,差异无显著意义（P〉0.05）.②治疗后,研究组与对照组子宫内膜组织生存素、雌激素受体和孕激素受体表达水平比较,差异无显著意义（P〉0.05）.研究组治疗前和治疗后随访6～12个月时,诊断性刮宫子宫内膜组织病理学类型比较,差异有显著意义（P＜0.01）.治疗后随访6～12个月时,研究组与对照组诊断性刮宫子宫内膜组织病理学类型比较,差异有显著意义（P＜0.01）.B式RF组治疗后随访6～12个月时, 子宫内膜被肉芽组织替代;A式RF组治疗后随访6～12个月时,诊断性刮宫内膜病理学类型多为少许内膜腺体和肉芽组织.③对照组治疗前,生存素、雌激素受体和孕激素受体表达在增生期样内膜、单纯性增生内膜和复杂性增生内膜三种病理类型中,阳性表达值比较,差异无显著意义（P〉0.05）.对照组治疗前及治疗后随访6～12月时,诊断性刮宫组织中,生存素,雌激素受体和孕激素受体表达比较,差异无显著意义（P〉0.05）. ④研究组经射频凝固子宫内膜治疗后,生存素、雌激素受体和孕激素受体表达水平,较治疗前明显下降,表达均明显低于治疗前（P＜0.05）.结论 治疗后,子宫内膜生存素、雌激素受体和孕激素受体的表达明显下降,是RF治疗无排卵性功能失调性子宫出血远期制止出血和防止复发的重要机制.
Objective To investigate the mechanism of radiofrequency （RF） heat-coagulation treatment of anovulatory dysfunctional uterine bleeding （DUB） by testing the expression levels of survivin, estrogen receptor（ER） and progesterone receptor （PR） in endometrium before and half year after treatment. Methods From June 2003 to December 2008, 76 cases of endometrium with anovulatory dysfunctionaluterine bleeding had undergone radiofrequency heat-coagulation treatment in the Department of Gynecology, the Military General Hospital of Jinan PLA. Pathological diagnosis of endometrial tissue from diagnostic curettage showed that 32 cases of simple hyperplasia, 28 of complex hyperplasia, and 16 of proliferative endometrium before treatment. A total of 76 cases were divided into A-type RF group and B-type RF group according to different ways of radiofrequency. A-type RF group conducted all endometrial coagulation-Atype coagulation, and B-type RF group conduced all endometrial coagulation-B-type coagulation. At the same time, another thirty eight cases with anovulatory dysfunctional uterine bleeding women were treated by conservative treatment （control group）. Pathological diagnosis of endometrial tissue from diagnostic curettage showed that 16 cases of simple hyperplasia, 12 of complex hyperplasia, and 10 of proliferative endometrium before treatment. Other gynecological diseases and gynecological cancer were not found in both two groups. All of them had not received any hormonal treatment measures nearly a month. Informed consent was obtained from all participants. There was no significant difference of age between two groups （P〉0.05）. The expression levels of survivin, estrogen receptor and progesterone receptor were detected by immunohistochemical S-P method before and follow-up 6 to 12 months after the treatment. Results （1）Pathological types of endometrial tissue from diagnostic curettage before and follow-up 6 to 12 months after treatment showed no significant difference of control group （P 〉 0. 05）. （2） Expressive levels of survivin, estrogen receptor and progesterone receptor after the treatment had no significant difference between two groups （P〉0.05）. Pathological types of endometrial tissue from diagnostic curettage of study group showed significant difference before and follow-up 6 to 12 months after the treatment of study group （P〈0.01）. Pathological types of endometrial tissue from diagnostic curettage showed significant difference in follow-up 6 to 12 months after treatment between two groups （P〈0. 01）. In 6 to 12 months after treatment, endometrium were placed by granulation tissue in A-type RF group, and pathological types of endometrial tissue by diagnostic curettage showed some endometrial glands and granulation tissue. （3） Before the treatment of control group, survivin, estrogen receptor and progesterone receptor expressed in simple hyperplasia, complex hyperplasia, and proliferative endometrium. Positive value among them had no significant difference （P 〉 0. 05）. （4） There were obviously statistical decrease of expressive levels of survivin, estrogen receptor and progesterone receptor after radiofrequeney treatment in half a year than those before the treatment of study group （P〈0. 05）. Conclusion The continued lower levels of survivin, estrogen receptor and progesterone receptor of the anovulatory dysfunctional uterine bleeding patients in study group is one of the important mechanism for treating anovulatory dysfunctional uterine bleeding by radiofrequency method.
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2010年第3期175-181,共7页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
关键词
无排卵性功能失调性子宫出血
经射频热凝固子宫内膜治疗
生存素
雌激素受体
孕激素受体
anovulatory dysfunctional uterine bleeding （anovulatory DUB）
radiofrequency heat- coagulation treatment（RF）
survivin
estrogen receptor（ER）
progesterone receptor （PR）
