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目的:探讨左炔诺孕酮宫内缓释系统对增生过长子宫内膜IGF-I和IGF-II及其相应受体表达的影响。方法:应用免疫组化链霉亲和素-生物素-过氧化物酶复合物方法检测20例子宫内膜增生过长患者宫内置入左炔诺孕酮宫内缓释系统前及置入3个月后子宫内膜IGF-I和IGF-II及其相应受体的表达,并设子宫内膜增生过长口服炔诺酮治疗3个月后患者子宫内膜对照组。结果:(1)宫内置入左炔诺孕酮宫内缓释系统3个月后,IGF-I表达下降,IGF-II的表达上升,与治疗前比较有显著性差异(P<0.05)。左炔诺孕酮宫内缓释系统治疗组子宫内膜IGF-I表达下降比炔诺酮治疗组明显,两者比较有显著性差异(P<0.05),IGF-II在左炔诺孕酮宫内缓释系统治疗后的子宫内膜的表达高于炔诺酮治疗后的子宫内膜,但统计学检验差异无显著性。(2)左炔诺孕酮宫内缓释系统治疗前后IGF-IR表达无显著性变化,P>0.05;炔诺酮对照组与左炔诺孕酮宫内缓释系统治疗后子宫内膜IGF-IR表达的比较亦无差异(P>0.05)。(3)宫内置入左炔诺孕酮宫内缓释系统3个月后,IGF-IIR表达增强,治疗前后比较有显著性差异(P<0.05);左炔诺孕酮宫内缓释系统治疗后子宫内膜IGF-IIR表达增加较炔诺酮治疗后的子宫内膜明显,两者差异有显著性(P<0.05)。结论:左炔诺孕酮宫内缓释系统通过抑制增生过长的子宫内膜IGF-I表达,上调IGF-II的表达,抑制雌激素对子宫内膜的增生效应并使子宫内膜发生蜕膜样变,是左炔诺孕酮宫内缓释系统治疗子宫内膜增生过长的重要机制。局部和血液循环孕激素浓度变化对IGF-IR表达无显著影响。宫内放置左炔诺孕酮宫内缓释系统对子宫内膜IGF系统的调节作用较口服炔诺酮显著。
Objective: To investigate the effect of levonorgestrel-releasing intrauterine system on the expression of IGF-I and IGF-II and their receptors in endometrial hyperplasia endometrium. Methods: Immunohistochemical streptavidin-biotin-peroxidase complex method was used to detect 20 patients with endometrial hyperplasia before intrauterine levonorgestrel-releasing intrauterine system and 3 Months after endometrial IGF-I and IGF-II and its corresponding receptor expression, and set endometrial hyperplasia oral norethisterone 3 months after treatment in patients with endometrial control group. Results: (1) After intrauterine administration of levonorgestrel intrauterine system for 3 months, the expression of IGF-I decreased and the expression of IGF-II increased, which was significantly different from that before treatment (P <0.05). Compared with norethindrone treatment group, the decrease of endometrial IGF-I expression in levonorgestrel-treated intrauterine system was significantly different (P <0.05), IGF-II in levonorgestrel The intrauterine release system after treatment of endometrial expression was higher than norethindrone after treatment of endometrial, but the statistical test was no significant difference. (2) There was no significant difference in the expression of IGF-IR before and after levonorgestrel intrauterine system release (P> 0.05). The norethindrone control group and levonorgestrel intrauterine system -IR expression was no difference (P> 0.05). (3) After intrauterine implantation of levonorgestrel intrauterine system for 3 months, the expression of IGF-IIR was enhanced and there was a significant difference before and after treatment (P <0.05); levonorgestrel intrauterine system Endometrial IGF-IIR expression increased after treatment compared with norethindrone treatment of endometrial significantly, the difference between the two was significant (P <0.05). CONCLUSION: Levonorgestrel-releasing intrauterine system can inhibit the hyperplasia of endometrium by inhibiting the proliferation of endometrial IGF-I, upregulating the expression of IGF-II, and inhibiting the proliferation of endometrium Membrane-like changes, levonorgestrel intrauterine system of sustained release of endometrial hyperplasia is an important mechanism. Local and circulating progesterone concentrations had no significant effect on IGF-IR expression. Intrauterine levonorgestrel intrauterine system of sustained release of endometrial IGF system regulation than oral norethindrone significantly.