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目的探讨多囊卵巢综合征(PCOS)无排卵患者子宫内膜超声形态学的变化特点,及组织学变化与激素水平的关系。方法采用B超观察76例PCOS无排卵患者(PCOS组)及32例排卵正常的不孕患者(对照组)的子宫内膜;按照Gonen等的分型方法,将子宫内膜分为A型(即低回声三线型)、B型(即均质中等回声)、C型(即强回声)3型;采用免疫组化技术,检测子宫内膜腺上皮细胞增殖相关核抗原Ki67及降钙素的表达;采用透射电镜观察子宫内膜超微结构;采用酶联免疫发光法,检测血清中黄体生成激素及孕酮等的水平。结果PCOS组子宫内膜为A型者23例,B型者34例、C型者17例,另2例患者因内膜厚度<5mm,未进行分型。A型患者的内膜间质发育异常比率为9%(2/23),B型和C型为43%(22/51)两者比较,差异有统计学意义(P<0·05)。PCOS组分泌期内膜腺上皮细胞Ki67表达为(14±6)%,对照组为(9±7)%,两组比较,差异有统计学意义(P<0·05)。PCOS组增生期子宫内膜腺上皮细胞中细胞器增多;分泌期显示分泌反应不良。结论PCOS无排卵患者子宫内膜呈现增生和分泌表现异常,其内膜超声形态学的强回声表现,可能与局灶性内膜间质发生异常组织学改变有关。
Objective To investigate the morphological changes of endometrial ultrasonography in patients with ovovascular polycystic ovary syndrome (PCOS) and the relationship between histological changes and hormone levels. Methods The endometrium of 76 patients with PCOS without ovulation (PCOS group) and 32 patients with normal ovulation (control group) were observed by B ultrasound. According to Gonen et al’s classification, the endometrium was divided into type A (Ie, hypoechoic three-line type), type B (ie, homogeneous medium echo) and type C (ie, hyperechoic) type 3. Immunohistochemistry was used to detect the proliferation of endometrial glandular epithelial cells associated with nuclear antigen Ki67 and calcitonin The ultrastructure of endometrium was observed by transmission electron microscopy. The levels of serum luteinizing hormone and progesterone were detected by enzyme-linked immunosorbent assay. Results In PCOS group, there were 23 cases with endometrial type A, 34 cases with type B and 17 cases with type C, and the other 2 cases were not typed due to intimal thickness <5mm. The rate of endometrial dysplasia was 9% (2/23) in type A patients and 43% (22/51) in type B and C (P <0.05). Ki67 expression in endometrial glandular epithelial cells was (14 ± 6)% in the PCOS group and (9 ± 7)% in the control group. There was significant difference between the two groups (P <0.05). PCOS group proliferative endometrial glandular epithelial cells organelles increased; secretory phase showed poor secretion. Conclusions The endometrial hyperplasia and secretory abnormalities in ovulation - prone patients with PCOS are abnormal. The echogenicity of endometrial ultrasound morphology may be related to abnormal histological changes of focal endometrial stroma.