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目的探讨血管内皮生长因子(vascular endothelial growth factor,VEGF)和碱性成纤维细胞生长因子(basic-fibroblast growth factor,b-FGF)在子宫腺肌病(adenomyosis,ADS)患者子宫内膜-肌层交界区(endometrial-myometrial interface,EMI)的表达及其与微血管密度(microvessel density,MVD)的相关性。方法选择2015年1月至2016年4月在首都医科大学附属北京妇产医院妇科微创中心因ADS行全子宫切除术的30例患者为ADS组(其中增殖期15例,分泌期15例);同期因宫颈病变而行子宫切除的20例患者为对照组(其中增殖期10例,分泌期10例)。通过免疫组化方法分别检测两组EMI区及ADS组远肌层的VEGF、b-FGF及CD 34(标记微血管密度)蛋白的表达,分析3者间的相关性。结果 (1)VEGF和b-FGF在ADS组及对照组EMI区的表达存在周期性变化。ADS组EMI区分泌期的表达(分别为3.460±0.322,3.210±0.364)高于增殖期(2.940±0.333,2.880±0.307),对照组EMI区分泌期的表达(分别为2.080±0.230,1.980±0.413)亦高于增殖期(1.720±0.326,1.340±0.362)(P均<0.05)。而VEGF和b-FGF在ADS组远肌层的表达无明显周期性变化。(2)无论增殖期还是分泌期,VEGF和b-FGF在ADS组EMI区的表达均高于远肌层和对照组EMI区(P均<0.05)。(3)MVD在两组EMI区及ADS组远肌层均呈周期性变化,其在ADS组EMI区分泌期计数(11.21±2.90)高于增殖期(10.22±2.85)条/40HP;在ADS组远肌层分泌期的计数(7.52±1.68)高于增殖期(6.15±1.25)条/40HP(P<0.05);其在对照组EMI区分泌期的计数(6.26±1.98)亦高于增殖期(5.75±1.01)条/40HP(P<0.05)。无论增殖期还是分泌期,MVD计数在ADS组EMI区明显高于远肌层和对照组,差异均有统计学意义(P<0.05)。(4)VEGF和b-FGF在两组EMI区的表达均显著相关;且两者的表达与两组EMI区MVD计数亦分别呈正相关(P均<0.05)。结论 VEGF和b-FGF在子宫腺肌病EMI区的表达明显增高,并且与MVD计数呈显著正相关。提示VEGF和b-FGF可能在ADS的血管形成及发生发展中起重要作用。
Objective To investigate the expression of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (b-FGF) in endometrial myometrium of patients with adenomyosis (ADS) (EMI) and its relationship with microvessel density (MVD) in the border area. Methods From January 2015 to April 2016, 30 patients undergoing total hysterectomy by ADS at Beijing Maternity Hospital Affiliated to Capital Medical University from January 2015 to April 2016 were ADS group (15 cases in proliferative phase and 15 in secretory phase) ; 20 cases of hysterectomy due to cervical lesions during the same period as the control group (including 10 cases of proliferative phase, secretory phase in 10 cases). The expressions of VEGF, b-FGF and CD34 (marker microvessel density) in far muscle of two groups of EMI area and ADS group were detected by immunohistochemistry, and the correlation among three groups was analyzed. Results (1) There was a periodic change in the expression of VEGF and b-FGF in the ADS and control groups. The expression of EMI in secretory phase of ADS group (3.460 ± 0.322,3.210 ± 0.364 respectively) was higher than that in proliferative phase (2.940 ± 0.333,2.880 ± 0.307), the secretion of EMI in control group was 2.080 ± 0.230 and 1.980 ± 0.413) were also higher than those in proliferative phase (1.720 ± 0.326,1.340 ± 0.362) (all P <0.05). The VEGF and b-FGF in the distal muscle of ADS group showed no significant periodic changes. (2) The expressions of VEGF and b-FGF in the ADS group were higher than those in the far muscle group and the control group (both P <0.05), both in proliferative phase and in secretory phase. (3) The MVD showed periodic changes in both the EMI and ADS distal muscular layers, which was significantly higher in the ADS group than in the proliferative phase (10.21 ± 2.85) / 40HP in the ADS group (11.21 ± 2.90) The number of distal myometrial secretory phase (7.52 ± 1.68) was higher than that of proliferative phase (6.15 ± 1.25) /40HP (P <0.05), and it was also significantly higher than that of proliferation in the control group (6.26 ± 1.98) Period (5.75 ± 1.01) / 40 HP (P <0.05). In both proliferative and secretory phases, the MVD count was significantly higher in the ADS group than in the far muscle and the control group (P <0.05). (4) The expressions of VEGF and b-FGF in both groups were significantly correlated. The expression of VEGF and b-FGF were also positively correlated with the MVD in the two groups (P <0.05). Conclusion The expression of VEGF and b-FGF in the adenoma of adenomyosis was significantly higher than that in the control group, and it was positively correlated with the MVD. It is suggested that VEGF and b-FGF may play an important role in angiogenesis and development of ADS.