TCM Syndrome Elements Characteristics And Expression Of ER,PR,TLR4/MyD88/NF-κB In Endometrial Polyps

Object i veBy retrospective investigation on clinical data of endometrial polyp and study on expression of estrogen receptor (ER), progesterone receptor (PR), Toll-like receptor 4 (TLR4), myeloid differentiation factor 88 (MyD88), nuclear factor κB (NF-κB) in endometrial polyps tissues, exploratory analysis for onset characteristics and TCM syndrome elements characteristics, excavation of intrinsic relationship between them, to provide TCM theoretical basis for control endometrial polyps; exploratory analysis for expression and significance of ER, PR, TLR4, MyD88 and NF-κ B and pathogenesis of endometrial polyps.MethodsClinical Study:Retrospectively study of endometrial polyps records, collect and gather the record information to analyze the clinical characteristics and TCM syndrome elements characteristics.Experimental Research:Collected endometrial polyps and normal endometrial tissue specimens which met the inclusion criteria. Measuring the expression of the experimental group and control group specimens ER, PR, TLR4, MyD88, NF-κB using immunohistochemical methods.ResultsClinical Research:1. General situation:477 patients with endometrial polyps, most aged 18 years, maximum 76 years old,26-35 year olds the highest incidence.2. Symptom Characteristics:the highest frequency of occurrence main complaint is "only ultrasound found abnormal endometrial echo", the longest complained duration is 40 years, the shortest is one day. The highest frequency of the main symptoms are "menstruation", "menorrhagia" and "infertility",44 patients had symptoms of hypomenorrhea.3. Menstrual and pregnancy history:383 cases of patients with an average age of menarche was 13.85±1.54 years,39 cases of postmenopausal patients with an average age of menopause was 50.82 ± 2.84 years, no significant difference (P>0.05) with normal female menarche and menopause age; the shortest menstrual cycle is 16 days, the longest is 90 days, the shortest period is three days, the longest is 20 days; 23 patients placed IUD; 353 cases of patients had a history of pregnancy, of which 306 cases had a history of production,56 patients have had adverse pregnancy history.4. Gynecological surgeries and endometrial polyps history:46 patients previously suffered from endometrial polyps, previously treated patients with gynecologic surgery related to a total of 231 cases,173 cases patients have had a history of uterine surgery,67 patients received more than twice uterine surgery.5. Ultrasound diagnosis:Ultrasound positive diagnosis rate was 70.9%, some patients ultrasonic tips atypical sonographic like thickened endometrial echo uneven, uterine fluid and abnormal cervical atypical echo.6. Surgery:The hysteroscopy+curettage is most, a total of 241 cases, 184 cases (38.8%) had a single polyp, two or more polyps were 216 cases (45.6%), while 74 cases (15.6%) patients showed no endoscopic polypoid neoplasms,30 patients with endometrial microscope, pale, meager. Polyp predilection position were uterine wall, a front wall, side walls, fundus and the uterine horn, minimum diameter is lmm, the maximum is 70mm. See 39 cases of cervical neoplasm, which 31 cases were diagnosed as cervical polyps. Endometrial thickness, polyp size, location and number of polyps and growth increased menstrual flow, menstrual period prolonged clinical symptoms was no statistically significant correlation (P>0.05).7. The final diagnosis:pathological diagnosis results showed that 80 cases of patients with endometrial simple hyperplasia,1 case with mild dysplasia, two cases of endometrial polyps carcinogenesis.297 patients with gynecologic or other body systems diseases, gynecological diseases, uterine fibroids account for first place, a total of 132 cases, endometriosis, ovarian endometriosis and adenomyosis patients with a total of 97 cases,92 infertility patients, including 43 patients with primary infertility, secondary infertility patients in 49 cases, the difference was not statistically significant (P>0.05). Other systems of systemic diseases, high blood pressure is the most, a total of 25 cases,15 cases of type 2 diabetes patients,5 patients with breast cancer surgery.8. TCM syndrome elementsudy:477 patients with Syndrome Distribution Syndrome top 10 followed Yaoxisuanruan, slow from a long illness, clamp block menstruation, dysmenorrhea, menstrual dark red, bulging breasts, menstruation, menstrual volume, infertility, vaginal bleeding. The top three of the tongue were pale tongue, dark red tongue, thin white fur; pulse followed veinlets, wiry pulse, the pulse. Press the weights>70 pairs of cases of disease bit sick of syndrome elements to organize, disease-bit syndrome elements, the highest frequency of the uterus, followed by the uterus+liver, disease resistance syndrome elements, the highest frequency of blood+stasis Qi stagnation, followed by blood stasis.9. The relationship between TCM syndrome elements and the disease characteristics:each bit sick and sick of syndrome element distribution in all age groups the difference was statistically significant (P<0.05). Number of pregnancies, production number, birth number with Blood hormone was negatively correlated, and the production number at the 0.01 level (bilateral) was statistically significant; induction frequency was positively correlated with blood stasis; number of pregnancies, production times, number of cesarean section and induction times were positively correlated with anemia, and the production number, number of cesarean section at the 0.01 level (bilateral) was statistically significant; number of pregnancies, production number, birth number and frequency induction Qi and positively correlated, and are at the 0.01 level (bilateral) was statistically significant; production number and birth times and uterus was negatively correlated; number of pregnancies, the production number, the number of abortions and liver were negatively correlated; induction frequency of liver was positively correlated; complained sustained length of time and blood stasis, qi stagnation, qi, the uterus was positively correlated, and at the 0.01 level (bilateral) was statistically significant; gynecological surgery and blood deficiency often positively correlated; the number of laparoscopic surgery and liver were positively correlated.Experimental Study:1. In endometrial polyps, endometrium and endometrial polyps next normal endometrium, no significant differences in the expression of ER; PR expression in endometrial polyps weakest, most normal endometrium, and in differences in the expression of three tissues was statistically significant (P<0.05).2. TLR4, MyD88 and NF-κ B expression in endometrial polyp group was significantly higher than in adjacent endometrial polyps and normal endometrium group, the difference was statistically significant (P<0.05), and in the normal uterus film group TLR4, MyD88 and NF-κ B positive expression of the weakest. TLR4 and MyD88, NF-κ B expression was positively correlated; MyD88 expression of NF-κ B and also positively correlated. PR and TLR4, MyD88, NF-κ B expression was negatively correlated.ConelusionClinical Research:1. The general onset characteristics of endometrial polyps:Endometrial polyps can occur in women of any age after puberty stage, the highest incidence rates of 26-35 years old. The incidence more than the occult, the main clinical manifestations of abnormal uterine bleeding, menstrual flow in order to extend and increase menstrual period is a common, except the patient nor the less menstruation. Polyps cause abnormal uterine bleeding depends on the type of pathology functional or non functional polyps. In the combined gynecological disease, uterine fibroids, endometriosis and adenomyosis, infertility highest frequency, but increase the number of pregnancy does not prevent the occurrence of endometrial polyps. And abortion, etc. repeated uterine surgery operation may promote the formation of endometrial polyps. Diagnosis, the use of ultrasound in the diagnosis of endometrial polyp screening there will be a certain rate of misdiagnosis, the final diagnosis still relies on histopathological examination. Treatment of pregnancy require the patient to be minimal impact on reproductive function in patients simultaneously TURP, the surgical procedure strictly control the scope and depth of the surgery, and how to take effective measures to prevent recurrence of endometrial polyps is still clinical work is a serious problem.2. Endometrial polyps TCM Prime Characteristic:Endometrial polyposis bit more in the uterus, liver, kidney, also see the two organs or organs with the patient, the disease of stagnation of qi, blood stasis syndrome is real Lord, we can see the actual situation were mixed. Because it is not very specific syndromes, most patients slow onset, longer duration, more changes accompanying menstruation, so some patients without clinical symptoms of particular disease and can not effectively determine its location and sick of syndrome element.3. Relations between the prime characteristics and TCM disease characteristics of endometrial polyps:endometrial polyps in patients of different ages, the disease venereal Slip factors also are differences. Uterus, liver and blood stasis syndrome elements of disease location, blood deficiency, qi, qi stagnation syndrome and other diseases of the hormone and complained of the length of time, number of pregnancies, production number, birth number, number of cesarean section, the number of abortions, abortion times laparoscopic surgery times and in varying degrees, the number of polyps were correlated. The past history of endometrial polyps positively associated with gynecologic surgery, uterine surgery and hysteroscopic surgery was.Experimental Study:ER expression was no significant difference in endometrial polyps, endometrial polyps and adjacent normal endometrium; PR weakest expression in endometrial polyps, the normal endometrium strongest. TLR4, MyD88 and NF-κ B expression in endometrial polyps strongest, weakest in normal endometrium. TLR4 and MyD88, NF-κ B expression was positively correlated; MyD88 expression of NF-κ B and also positively correlated. PR and TLR4, MyD88, NF-κ B expression was negatively correlated to infer TLR4/MyD88/NF-κ B activation may be involved in the occurrence of endometrial polyps, low PR may TLR4/MyD88/ NF-κ B overactivation related to the need to be confirmed by further experiments. Visible, endometrial polyps may be the endometrium local immune inflammation, endocrine abnormalities and cell death result of joint action adjusting imbalances.