全球精选文摘 - 释放左炔诺酮的IUD及口服醋酸甲羟孕酮对人类子宫内膜增生患者腺体和间质孕激素受体（PRA和PRB）及雌激素受体（ER-α和 ER-β）的影响

Effect of levonorgestrel IUD and oral medroxyprogesterone acetate on glandular and stromal progesterone receptors (PRA and PRB), and estrogen receptors (ER-α and ER-β) in human endometrial hyperplasia

Vereide AB, Kaino T, Sager G 2009/5/27 10:50:40

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Gynecol Oncol, 2006,

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Abstract

Objectives:

The effect on progesterone and estrogen receptor expression in glands and stroma after two different treatment regimens of endometrial hyperplasia was determined.

Methods:

Pre- and post-treatment paraffin-embedded endometrial hyperplasia specimens from women treated with levonorgestrel (LNG) intra-uterine device (n = 21) and women treated with 10 mg medroxyprogesterone acetate (MPA) for 10 days per cycle (n = 29) were examined immunohistochemically and evaluated by H-score (a semi-quantitative microscopical method evaluating staining intensity and number of stained cells, scale 0–3) for changes in expression of PRA (progesterone receptor A), PRB (progesterone receptor B), ER-α (estrogen receptor-α), ER-β (estrogen receptor-β) and AR (androgen receptors) after 3 months of treatment.

Results:

All the patients in the LNG IUD group responded to treatment with no sign of hyperplasia after 3 months, while only about half of the patients given MPA orally responded. Expression of PRA, PRB, ER-α and ER-β were markedly reduced after progestin treatment in both treatment groups but the reduction was much more pronounced in the LNG group (H-score for PRA was reduced from 2.61 to 0.11 in glands and from 2.26 to 0.09 in stroma in LNG group. Corresponding reduction for PRB in the LNG group was from 1.96 to 0.11 and from 0.83 to 0.01. PRA was reduced from 2.53 to 1.78 in glands and from 1.93 to 1.30 in stroma in the MPA group. Corresponding reduction for PRB in the MPA group was from 2.02 to 1.25 in glands and from 0.80 to 0.34 in stroma). Weak and focal stromal expression of AR was demonstrated in 22% of the specimens before but not after therapy. There was a statistically significant reduction in both PR and ER among the responders whereas non-responders showed no statistical change after treatment.

Conclusion:

The present study shows that LNG IUD causes an almost complete down-regulation (lack of immunohistochemical expression) of PR expression and a considerable down-regulation of ER expression in both glands and stroma. The changes in receptor expression were markedly less pronounced after treatment with intermittent oral MPA. The differences in receptor expression among responders and non-responders might serve as possible markers for therapy response.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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