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目的探讨绝经过渡期妇女子宫内膜雌激素受体两亚型ERα和ERβ在子宫内膜癌变发生过程中的变化及对细胞增殖的意义。方法2003-2004浙江大学医学院附属妇产科医院对30例增生期子宫内膜、30例过度增生、30例不典型增生子宫内膜、38例子宫内膜腺癌组织,采用免疫组化的方法检测ERα和ERβ的表达,同时检测细胞核增殖相关抗原Ki67的表达。结果子宫内膜过度增生组ERα的表达较增生期子宫内膜增加(P<0·05),而ERβ的表达无明显改变(P>0·05)。不典型增生组和子宫内膜癌组ERα的表达逐步降低(P<0·05)。不典型增生组ERβ的表达显著下降(P<0·05),子宫内膜癌组ERβ的表达与不典型增生组比较差异无统计学意义(P>0·05)。不典型增生组ERα/ERβ的比值增加,而子宫内膜癌组ERα/ERβ的比值显著降低(P<0·05)。过度增生组Ki67标记指数(Ki67PI)较增生期内膜组有上升趋势,但差异无统计学意义(P>0·05)。不典型增生组、子宫内膜癌组Ki67PI逐步上升,差异均有统计学意义(P<0·05)。在增生期内膜和过度增生组,Ki67PI的表达与ERα正相关(r=0·39,P=0·02)。Ki67PI的表达与ERα/ERβ正相关(r=0·48,P=0·01)。结论ERα和ERβ在子宫内膜从良性病变到癌前病变到癌的进展过程中都起了重要的作用,ERα、ERβ的平衡失调在子宫内膜癌的发生过程中起着更为重要的作用。
Objective To investigate the changes of endometrial estrogen receptor subtypes ERα and ERβ in endometrial carcinogenesis and the significance of cell proliferation in menopausal women. Methods A total of 30 cases of proliferative endometrium, 30 cases of hyperproliferation, 30 cases of atypical hyperplasia endometrium and 38 cases of endometrial adenocarcinoma were treated by Affiliated Obstetrics and Gynecology Hospital of Zhejiang University from 2003 to 2004. Immunohistochemistry Methods The expressions of ERα and ERβ were detected and the expression of Ki67 in the nucleus was detected. Results The expression of ERα in endometrial hyperplasia group was higher than that in proliferative endometrium (P <0.05), while the expression of ERβ was not significantly changed (P> 0.05). The expression of ERα in atypical hyperplasia group and endometrial carcinoma group decreased gradually (P <0.05). The expression of ERβ in atypical hyperplasia group was significantly lower than that in atypical hyperplasia group (P <0.05). There was no significant difference in the expression of ERβ in atypical hyperplasia group (P> 0.05). The ratio of ERα / ERβ increased in atypical hyperplasia, while the ratio of ERα / ERβ in endometrial carcinoma decreased significantly (P <0.05). The Ki67 labeling index (Ki67PI) in overgrowth group was higher than that in proliferative endometrium group, but the difference was not statistically significant (P> 0.05). Ki67PI in atypical hyperplasia group and endometrial carcinoma group increased gradually, the differences were statistically significant (P <0.05). In the proliferative endometrium and hyperplasia group, Ki67PI expression was positively correlated with ERα (r = 0.39, P = 0.02). Ki67PI expression was positively correlated with ERα / ERβ (r = 0.48, P = 0.01). Conclusions ERα and ERβ play an important role in the progress of endometrial cancer from benign to precancerous lesions to carcinogenesis. The imbalance of ERα and ERβ play a more important role in the pathogenesis of endometrial cancer .