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目的探讨临床子宫腺肌病的在位内膜和病灶组织中神经营养因子-3(NT-3)蛋白的表达及其与临床痛经的关系。方法因子宫腺肌病行子宫切除术后的标本60例作为研究组,其中在位内膜、异位内膜各30例;另选同期因子宫刮诊术并经病理检查证实的正常子宫内膜组织30例作为对照组。比较两组的阳性率,并分析其临床疼痛表现。结果子宫腺肌病异位内膜增殖期、分泌期表达均强于正常子宫内膜表达;子宫腺肌病肌层表达强于正常子宫肌层表达,而且子宫腺肌病在位内膜增殖期、分泌期腺管染色明显不同,胞质染色强度阳性,病灶中染色强度与内膜染色无差异,但与正常子宫内膜表现有差异。在研究组内膜中的神经营养因子表达呈高表达表现,疼痛表达评分越高,神经营养因子在子宫腺肌病内膜中的表达越呈增高趋势,在位内膜中无痛经者阳性率为77.8%(7/9),轻度、中度、重度痛经者表达分别为85.7%(6/7)、90.9%(10/11)、100.0%(3/3)。而异位内膜中的神经营养因子表达在无痛经、轻、中、重度痛经者中的表达分别为44.4%(4/9)、71.4%(5/7)、90.9%(10/11)、100.0%(3/3)。除了无痛经者和轻度痛经者阳性率表达差异无统计学意义(P>0.05),其余的中、重度痛经者与无痛经者相比差异均有统计学意义(P<0.05)。结论子宫腺肌病痛经症状与NT-3关系密切,有针对性的拮抗外周神经营养因子和抑制中枢神经元的增加,有可能为痛经治疗提供新的研究方向。
Objective To investigate the expression of neurotrophic factor-3 (NT-3) protein in eutopic and focal eutopic endometrium of clinical adenomyosis and its relationship with clinical dysmenorrhea. Methods 60 cases of adenomyosis after hysterectomy specimens as the research group, including ectopic endometrium and ectopic endometrium in each 30 cases; the same period due to hysterospatial diagnosis and confirmed by pathological examination of normal uterus Membrane tissue in 30 cases as a control group. The positive rates of the two groups were compared and their clinical pain performance was analyzed. Results Adenomyosis ectopic endometrium proliferative phase and secretory phase expression were stronger than normal endometrial expression; adenomyosis myometrial expression is stronger than normal myometrium, and adenomyosis in eutopic endometrial hyperplasia , Secretory ductal staining was significantly different cytoplasm staining intensity was positive, the staining intensity in the lesion was not different from the staining of the endometrium, but with the normal endometrium there are differences. In the study group, the expression of neurotrophic factor in the endometrium was highly expressed. The higher the pain expression score, the higher the expression of neurotrophic factor in the endometrium of adenomyosis. The positive rate of no pain in endometrium And 77.8% (7/9) respectively. The expressions in mild, moderate and severe dysmenorrhea were 85.7% (6/7), 90.9% (10/11) and 100.0% (3/3), respectively. The expression of neurotrophic factor in ectopic endometrium were 44.4% (4/9), 71.4% (5/7), 90.9% (10/11) respectively in non-dysmenorrhea, mild to moderate to severe dysmenorrhea, , 100.0% (3/3). There was no significant difference in the positive expression rate among those with no dysmenorrhea and those with mild dysmenorrhea (P> 0.05). There was significant difference between the other moderate and severe dysmenorrhea patients and those with no dysmenorrhea (P <0.05). Conclusions The symptoms of dysmenorrhea in adenomyosis are closely related to NT-3, antagonize the increase of peripheral neurotrophic factor and inhibit the central neuron in a targeted manner, which may provide a new research direction for the treatment of dysmenorrhea.