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目的研究子宫腺肌症患者放置左炔诺孕酮宫内缓释系统(LNG-IUS)后子宫内膜血管内皮生长因子(VEGF)、促血管生成素(Ang-1、Ang-2)表达的变化,从血管生成及血管稳定性方面探讨子宫腺肌症患者放置LNG-IUS后不规则出血的发生机制。方法收集41例放置LNG-IUS腺肌症患者的子宫内膜,应用免疫组化染色(DAKO EnvisionTM System法)检测其子宫内膜VEGF、Ang-1、Ang-2的表达水平,同时设立子宫腺肌症对照组(16例)。结果放置LNG-IUS后异常出血组(16例)子宫内膜VEGF、Ang-2表达较无异常出血组(25例)增高,差异有统计学意义(P<0.05);而Ang-1在异常出血组与无异常出血组子宫内膜的表达差异无统计学意义(P>0.05)。根据LNG-IUS放置年限不同,将放置LNG-IUS的患者分为放置1年内组、放置1～2年组、放置2年以上组。放置1～2年组、放置2年以上组子宫内膜VEGF、Ang-2表达比放置1年内组低,差异有统计学意义(P<0.05)。Ang-1在不同放置年限组间差异均无统计学意义(P>0.05)。结论 VEGF、Ang-1、Ang-2可能通过影响微血管生成及血管稳定性参与LNG-IUS的出血副反应。
Objective To study the expression of endometrial vascular endothelial growth factor (VEGF), angiopoietin (Ang-1, Ang-2) in patients with adenomyosis after levonorgestrel-releasing intrauterine release system (LNG-IUS) Variations of angiogenesis and vascular stability in patients with adenomyosis after LNG-IUS placement of irregular bleeding mechanism. Methods The endometrium of 41 patients with LNG-IUS adenomyosis was collected. The expression of VEGF, Ang-1 and Ang-2 in endometrium was detected by immunohistochemistry (DAKO EnvisionTM System) Muscular control group (16 cases). Results The expression of VEGF and Ang-2 in abnormal endometrium of LN group was significantly higher than that of non-abnormal group (25 cases) (P <0.05) after LNG- There was no significant difference in the expression of endometrium between hemorrhage group and non-hemorrhage group (P> 0.05). According to different LNG-IUS years of placement, patients with LNG-IUS were divided into 1 year group, 1 to 2 year group, and 2 year group. After 1 to 2 years of operation, the expression of VEGF and Ang-2 in the endometrium of more than 2 years old group was lower than that of 1-year old group, with significant difference (P <0.05). There was no significant difference in Ang-1 between years of placement (P> 0.05). Conclusion VEGF, Ang-1 and Ang-2 may participate in the hemorrhagic side effects of LNG-IUS by affecting the angiogenesis and vascular stability.