摘要
目的 探讨子宫结合带的超微结构特点及间隙连接蛋白43（Cx43）在子宫结合带中的表达变化与子宫腺肌病发病的关系.方法 收集2008年11月至2009年11月在内蒙古医学院附属医院妇科住院的因子宫腺肌病行子宫全或次全切除术者30例为观察组（其中子宫内膜为增生期14例,分泌期16例）,选择同期因宫颈上皮内瘤变（CIN）Ⅲ等行子宫全切除术者30例为对照组（子宫内膜为增生期、分泌期各15例）.采用链霉素亲和素-生物素-过氧化物酶复合物（SABC）免疫组化法检测Cx43蛋白在子宫腺肌病患者子宫结合带中的表达水平,以吸光度（A）值表示;透视电镜观察两组中无诊断性刮宫（诊刮）史、剖宫产史、子宫手术史者（各4例）的子宫在位内膜、子宫结合带以及子宫肌层外1/3的超微结构特点.结果 （1）Cx43蛋白的表达：观察组增生期及分泌期子宫结合带中Cx43蛋白表达水平分别为0.133±0.018、0.137±0.021,对照组分别为0.154±0.016、0.141±0.018,两组同一期别子宫内膜比较,差异均有统计学意义（P＜0.05）,但各组内增生期与分泌期子宫结合带中Cx43蛋白表达水平比较,差异无统计学意义（P＞0.05）;观察组的在位内膜中增生期及分泌期Cx43蛋白表达水平（0.067±0.017,0.062±0142）低于对照组（0.094±0.005,0.080±0.005）,差异也均有统计学意义（P＜0.05）,但各组内增生期与分泌期比较,差异无统计学意义（P＜0.05）;观察组和对照组增生期外肌层Cx43蛋白表达分别为0.184±0.022、0.188±0.028,差异无统计学意义（P＞0.05）,分泌期外肌层Cx43蛋白表达分别为0.178±0.022、0.191±0.025,差异也无统计学意义（P＞0.05）.（2）形态学变化：观察组子宫结合带平滑肌细胞核面积[（24.3±1.6）μm2]比对照组[（21.8±2.0）μm2]明显增加,差异有统计学意义（P＜0.01）.细胞膜致密斑明显增长[（1.07±0.17）、（0.71±0.07）μm],差异也有统计学意义（P＜0.01）;观察组子宫结合带肌细胞小凹结构减少,细胞增生肥大,排列紊乱,核表面呈圆齿状不规则外形,核染色质边集,异染色质多,细肌丝较少而中间丝较多,线粒体数量增加、体积增大、空泡化明显,粗面内质网扩张,高尔基体增加,肥大细胞与肌细胞紧密相邻;在位内膜的腺上皮细胞间呈桥粒连接,且表面绒毛增粗、致密.以上特点在观察组的外肌层也可见,但没有子宫结合带显著.结论 子宫结合带中超微结构的变化和Cx43蛋白的表达下调可能与子宫腺肌病的发病有关.
Objective To investigate the relationship between the ultrastructural features combined with the expression of connexin （ Cx43 ） protein in uterine junction zone and pathogenesis of adenomyosis.Methods From Nov. 2008 to Nov. 2009, 30 patients with adenomyosis （including 14 cases with proliferative endometrium and 16 cases with secretory endometrium） as study group matched with 30 women with cervical intraepithelial neoplasia （GIN） Ⅲ treated by hysterectomy as control group were enrolled in this study in Affiliated Hospital to Inner Mongolia Medical College. The expression of Cx43 in uterine junction zone of patients with adenomyosis was detected by immunohistochemisty staining. The ultrastucture of eutopic endometrium, uterine junction zone and outer 1/3 myometrium in both groups without history of dilatation and curettage, C-section and uterine surgery were observed by using transmission electron microscopy. Results （ 1 ）The expression of Cx43 in proliferative and secretroy uterine junction zone were 0.133 ±0.018 and 0.137 ± 0.021 in study group and 0.154 ±0.016 and 0.141 ±0.018 in control group,which reached statistical difference （P ＜0.05）. However, it didn＇t show significant expression of Cx43 between proliferative and secretory uterine junction zone in study or control group （ P ＞ 0.05 ）. The expression of Cx43 in proliferative and secretory of eutopic endometrium of 0.067 ± 0.017 and 0.062 ± 0142 in study group were significantly lower than 0.094 ±0.005 and 0.080 ±0.005 in control group. It didn＇t show statistical difference of Cx43 expression between proliferative and secretroy eutopic endometrium in both group. The expression Cx43 in outer myometrium of proliferative phase were 0.184 ± 0.022 in study group and 0.188 ± 0.028 in control group, which did not show significant difference （P ＞0.05）. It also did not exhibit statistical difference of Cx43 expression in outer myometrium of secretory phase （0.178 ± 0.022,0.191 ± 0.025,P ＞0.05）. （2） Morphological changes： the area of uterine smooth muscle cells of the uterine junction zone of （24. 3 ± 1.6） μm2 in study group were significantly increased than （21.8 ±2.0）μm2 in control group （P ＜ 0.01 ）. The length of the cell membrane dense plaques of （1.07 ± 0. 17 ）μm in study group was significantly increased than （0.71 ±0.07） μm in control group （P ＜0.01 ）. The myocytes exhibited cellular hypertrophy and disordered arrangement and fewer caveolae. There was cylindrical and dentate, chromatin margination, more heterochromatin in which muscle cells of nuclear surface of the uterine junction zone. Less cytoplasmic myofilaments and more intermediate filaments. Mitochondria were increased,the volume increased significantly vacuolization. The rough endoplasmic reticulum and Golgi apparatus were more prominent. Otherewise, mast cells and fibroblasts were close and glandular epithelial cells showed desmosome connection which villus thickening and dense. All features were more prominent at the junctional zone. Conclusions The down-regulation of Cx43 expression and ultrastructure changes in the junction zone might play an important role in pathogenesis of adenomyosis.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2010年第10期762-766,共5页
Chinese Journal of Obstetrics and Gynecology
