The Study For The Interrelation Between Endometriosis & Angiogenesis And Proliferation

Objective:The purpose of this study was to investigate the expression of the correlation factors of angiogenesis, including vascular epithelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) and the expression of a proliferative marker Ki-67 on eutopic endometrium (Eu-em) and ectopic endometrium (Ec-em) of endometriosis (EMs) or adenomyosis (Am), and to investigate the expression of VEGF in peritoneal fluid (PF) of endometriosis.Materials and methods:1. Patients were obtained from the Dep. of Gyn. & Obs. in the PLA General Hospital undergoing laparoscopy and total vaginal hysterectomy from April to October in 2004. There were 20 cases respectively in 5 groups, including Eu-em and Ec-em groups in EMs or Am and the controls of normal endometrium, derived from the patients undergone surgical operation for the case of infertility or other benign gynecological diseases. The expression of VEGF and bFGF during menstrual cycle and its correlationship withKi-67 were analysed by immunohistochemical dual staining. There were 47 cases in the VEGF group, including 16 cases of Eu-em and 5 of Ec-em of EMs, 15 Eu-em and 12 Ec-em of Am, and 16 normal controls. There were 44 cases in the bFGF group, including 14 cases of Eu-em of EMs, 16 Eu-em and 14 Ec-em of Am, and 14 normal controls.2. PF was obtained from 60 cases of patients in the PL A General Hospital undergoing laparoscopy from October in 2004 to April in 2005. There were 40 cases of EMs, including 13 of I -II stage and 27 of El-IV stage, and 20 controls. The change of VEGF content of PF was investigated by ELISA methods in the[0] controls and groups of different stages of EMs. Simultaneously, we also studied the effect of VEGF in PF on the pathogenesis of EMs.Results:1. The expression of VEGF, Ki-67 and bFGF on Eu-em of EMs:? VEGF: There was a less variation of cyclic speciality of VEGF expression in the glandular epithelial cells(GEC) on EU-em of EMs. The expressive rate of VEGF was higher in the stromal cells (SC) during the secretion than that in the proliferation, which was contrary to the control's cyclic speciality. The variation betweenEMs group and controls was significant. (P<0.05).? Ki-67: The Ki-67 expression was higher during the secretion inGEC on Eu-em of EMs than that in the proliferation, which wascontrary to control's cyclic speciality. The variation wassignificantly between EMs group and controls (PO.05). Nosignificant variation were seen on the Ki-67 expression in SCbetween Eu-em of EMs and normal controls. (P>0.05).(3) bFGF: The expression of bFGF was higher both in proliferationand secretion in SC on Eu-em of EMs than that in other groups(P<0.05).2. The expression of VEGF, Ki-67 and bFGF on Eu-em of Am:? VEGF: The variation of cyclic speciality of VEGF expressionbecame less in SC on Eu-em of Am. The VEGF expression inGEC was higher during the secretion than that in the proliferation,which was contrary to control's cyclic speciality The variation wassignificant between Am group and controls (P<0.05).? Ki-67: There was a reduced expression of Ki-67 in GEC and asignificantly reduction in SC on Eu-em of Am. The variation wassignificant between Am group and control group (P<0.05).? bFGF: The expression of bFGF was higher in GEC during thesecretion than that in the proliferation (P<0.05).3. The expression of VEGF, Ki-67 and bFGF on normal endometrium in controls:CD VEGF: The expression of VEGF showed a cyclic speciality on normal endometrium. The expression of VEGF was higher during proliferation than that in secretion (P<0.05).(2) Ki-67: The expression of Ki-67 in GEC on normal endometrium was cyclic, and was higher during proliferation than that in secretion. The expression of Ki-67 in SC was very high and did not show a cyclic speciality (PO.05).(3) bFGF: The expression of bFGF showed a cyclic change in SC, which was higher during the proliferation than that in the secretion(P<0.05). The VEGF content of PF was associated with the grade of EMs. It was higher in the HI-IV stage than that in the I - II stage and the controls(P<0.05).Conclusion:1. The expression of VEGF, Ki-67 and bFGF shows a cyclic speciality on normal endometrium, which is higher during proliferation than that in the secretory phase. These are interrelated with the physiological repairing function of normal endometrium.2. The expression of VEGF, Ki-67 and bFGF loses a cyclic speciality in SC or GEC on Eu-em of EMs or Am.The expressiverate increases during secretion. These indicate that the abnormal expression of genes on Eu-em of EMs plays a leading role in the fact that eutopic endometrium has an increased capacity to implate and survive ectopically after retrograde menstruation. These proved the theory of "the leading role of eutopic endometrium".3. The interrelationship between the VEGF content of PF and the grade of EMs indicates that VEGF in PF may be derived from ectopic endometrium.