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目的寻找出子宫内膜异位症(EMs)合并子宫内膜息肉(EP)不孕的发病机制。方法随机选取2002年7月至2008年4月在中山大学第一附属医院经临床及病理确诊EMs合并EP育龄妇女,分为研究组和对照组,研究组14例(原发不孕者)包括增殖期9例,分泌期5例;对照组(有妊娠史)23例,增殖期14例,分泌期9例。采用免疫组化SP法,对EP组织进行血管内皮生长因子A(VEGF-A)、CD34检测,结合显微图像进行分析。结果 EMs合并EP的原发不孕患者中,7例息肉在增殖期VEGF-A阳性细胞数为726.93±274.75,EMs合并EP有妊娠史的患者中,14例息肉在增殖期VEGF-A阳性细胞数为535.24±143.05,原发不孕组EP在增殖期VEGF-A阳性细胞较高。EMs合并EP有妊娠史的患者中,14例息肉在增殖期VEGF-A阳性细胞面积的面密度与微血管密度(MVD)的相关系数为0.64,呈正相关(P<0.05),EMs合并EP有妊娠史的患者中,9例息肉在分泌期VEGF-A阳性细胞数与MVD的相关系数为-0.75,呈负相关(P<0.05)。结论 EMs合并EP导致不孕可能与VEGF-A升高有关。在增殖期息肉内VEGF-A与MVD无正相关、分泌期无负相关可能是EMs合并息肉患者的不孕原因之一。
Objective To find out the pathogenesis of endometriosis (EMs) with endometrial polyps (EP) infertility. Methods From July 2002 to April 2008, women with childbearing age and EMs diagnosed clinically and pathologically in the First Affiliated Hospital of Sun Yat-sen University from July 2002 to April 2008 were divided into study group and control group. The study group included 14 cases (primary infertility) 9 cases of proliferative phase, 5 cases of secretory phase; 23 cases of control group (with pregnancy history), 14 cases of proliferative phase and 9 cases of secretory phase. The immunohistochemical SP method was used to detect the expression of vascular endothelial growth factor A (VEGF-A) and CD34 in EP tissues and the microscopic images were analyzed. Results In the primary infertile patients with EMs complicated with EP, the number of VEGF-A positive cells in 7 cases of polyps was 726.93 ± 274.75 in proliferative phase and 14 cases of polyps in proliferative phase of EMs with EP. The number of 535.24 ± 143.05, primary infertility group EP in proliferating phase VEGF-A positive cells higher. There was a positive correlation between the density of VEGF-A positive cells and the density of microvessel density (MVD) of 14 cases of polyp in EMs with EP (P <0.05) Among the patients with history, the correlation coefficient between the number of VEGF-A positive cells in secretory phase and MVD was -0.75 (P <0.05). Conclusion EMs combined with EP lead to infertility may be related to elevated VEGF-A. There was no positive correlation between VEGF-A and MVD in polyp during proliferative phase, and no negative correlation in secretory phase was probably one of the causes of infertility in patients with EMs complicated with polyp.