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目的:研究促性腺激素释放激素激动剂(GnRHα)对子宫内膜异位症(EMs)患者在位内膜蛋白表达的影响,为EMs的治疗提供依据。方法:94例EMs患者随机分为两组,每组47例,均实施腹腔镜手术治疗,对照组未给予药物治疗,观察组给予曲普瑞林皮下注射,28日/次,注射3次,术中及治疗三个月后观察组分别用取内膜器取少量子宫内膜组织标本,采用免疫组化法法、TUNEL染色法和Western blot检测组织内Bcl-2、Caspase3、GRP78等表达情况,并观察治疗效果。结果:治疗后观察组疼痛视觉模拟评分(VAS)为(2.13±0.69)分,低于对照组的(2.62±0.71)分(P<0.05);观察组1年内妊娠率及总妊娠率分别为38.30%、51.06%,均高于对照组的19.15%、29.79%(P<0.05);治疗后观察组Bcl-2、Caspase3表达量分别为(1.54±0.28)、(3.20±0.65),均高于对照组的(1.38±0.15)、(1.24±0.27)(P<0.05);治疗后观察组GRP78表达量为(0.46±0.17),低于对照组的(0.61±0.24)(P<0.05)。结论:GnRHα可缓解EMs患者下腹痛、痛经、性交痛等症状,提高妊娠率,其机制可能与GnRHα调控上皮细胞Bcl-2、Caspase3、GRP78等的表达有关。
Objective: To study the effect of gonadotropin-releasing hormone agonist (GnRHα) on the expression of endomembrane protein in endometriosis (EMs) patients, and to provide basis for the treatment of EMs. Methods: Ninety-four patients with EMs were randomly divided into two groups, 47 cases in each group. All patients underwent laparoscopic surgery without drug treatment. The patients in the observation group were subcutaneously injected with triptorelin on the 28th day for 3 times, Intraoperatively and three months after treatment, the observation group were given a small amount of endometrium take endometrial tissue specimens, immunohistochemistry, TUNEL staining and Western blot detection of the expression of Bcl-2, Caspase3, GRP78 , And observe the effect of treatment. Results: After treatment, the pain visual analogue scale (VAS) in the observation group was (2.13 ± 0.69) points lower than that in the control group (2.62 ± 0.71) points (P <0.05). The pregnancy rate and total pregnancy rate in the observation group were 38.30% and 51.06%, respectively, which were higher than that of the control group (19.15% and 29.79%, P <0.05). The expression of Bcl-2 and Caspase3 in the observation group were (1.54 ± 0.28) and (3.20 ± 0.65) (1.38 ± 0.15) and (1.24 ± 0.27), respectively (P <0.05). The expression of GRP78 in the observation group after treatment was (0.46 ± 0.17), which was lower than that in the control group (0.61 ± 0.24) . CONCLUSION: GnRHα can relieve the symptoms of lower abdominal pain, dysmenorrhea and painful intercourse in patients with EMs and improve the pregnancy rate. The mechanism may be related to the regulation of GnRHα on the expression of Bcl-2, Caspase3 and GRP78 in epithelial cells.