| Endometrial Polyps (EP) is a kind of common benign uterine cavity disorder. In recent years, with the improvement of transvaginal ultrasound and Hysteroscopy, the preoperative diagnosis of the disease was significantly increased. According to some reports ,the incidence rate of EP is about 24% to 25%, the rate of malignant transformation is about 1% to 1.6%. Especially in postmenopausal women, the rate of incidence and canceration are higher than those in premenopausal women, that has seriously affected the health of the women.At present, there are several hypothesis about the cause of EP : Traditionally, EP is a kind of reactive hyperplasia which relates to inflammation; It can also be thought that the EP is a kind of benign tumor of the endometrium; some scholars suspect that EP is a kind of precancerous lesions ,witch is similar to colorectal polyps; some consider that the pathogenesis of EP is related to endocrine disturbance in premenopausal women; Recent researches show that the occurrence of EP has genetic basis; In the field of molecular biology, many researches show that abnormal regulation of apoptosis plays a very important role in the development of EP, and a large number of experiments show that some factors that relates to apoptosis regulation, such as bcl-2, Ki-67, ras and PTEN ,take part in the development of EP. However, the exact etiology and pathogenesis have not been clear yet.Survivin and COX-2 gene are new-found anti-apoptotic genes. Large number of studies show that they are highly expressed in majority benign and malignant tumors, and their high expression related to the stage and prognosis of tumors closely. Survivin gene is a kind of anti-apoptosis gene, it plays an important role in apoptosis and mitosis. Survivin gene expresses in majority of tumor cells and embryonic tissue, and doesn't express in majority normal tissues, that shows that it may promote the genesis and development of tumor. Cyclooxygenase (COX) is the rate-limiting enzyme, and catalyzes the convertion of arachidonic acid to prostaglandins. Cyclooxygenase-2(COX-2) is one of the two isoenzyme of COX, which can be stimulated by a variety of factors both inside and outside the cells, and than its expression in tissues increases. Many scholars think that COX-2 can promote the development of tumors mainly by playing a role in stimulating cell growth , suppressing apoptosis, and promoting angiogenesis. Most studies show that Survivin and COX-2 express highly in the majority of benign and malignant tumors in gynecology, but the exact mechanism have not reached a consensus yet. And the expression and relationship of Survivin and COX-2 in endometrial polyp tissue has not been reported either. The experiment aim to study the expression and the relationship of Survivin and COX-2 in endometrial polyps in postmenopausal women, to research the pathogenesis of EP, so that we will provide theoretic basis for aetiology and mechanism of endometrial polyps and find a new way for its effective remedy.Immunohistochemical method was used to detect the expression of Survivin and COX-2 protein in 30 cases of endometrium without endometrial polyps (control group), 40 cases of endometrial polyps (polyps group), and 40 cases of endometrium with endometrial polyps (endometrial group). All the subjects are postmenopausal women, and the time from their last menstrual period (LMP) to now are all more than one year. Concise statistical software 10.32 was performed to analyze the study data. Statistical significance was defined as P<0.05. Linear correlation analysis and Spearman rank correlation analysis were used to analyse the relationship between the two factors.The results show that: Survivin and COX-2 protein was expressed in the epithelium of all the groups with different levels, and it mainly localized in the cytoplasm. The positive rate of Survivin protein in control group (6.67%), endometrial group (22.5%) and polyps group (67.5%) were gradually increased. The expression of Survivin protein was significantly higher in polyps group than that in control group and endometrial group (P <0.05). But the expression of Survivin in control group and endometrial group showed no significant difference (P>0.05). The positive rate of COX-2 protein in control group (6.67%), endometrial group (10%) and polyps group(27.5%) were gradually increased too. The expression in polyps group was significant higher than the other two (P <0.05). But the expression in control group and endometrial group showed no significant difference (P>0.05). The expression of Survivin and COX-2 protein in endometrial polyps was positively correlated. We can draw the following conclusions: The high expression of Survivin and COX-2 protein in endometrial polyps may related to the genesis, the development and the malignant transformation of endometrial polyps. And we may presume that Survivin and COX-2 protein are closely involved in the development of endometrial polyps through various path and mechanisms. Moreover, we can speculate that Cox-2 and Survivin protein have cooperative effect in the genesis and development of endometrial polyps, such as stimulating cell growth, inhibiting apoptosis, and promoting angiogenesis synergistically, and this could be one mechanism of the formation and development of endometrial polyps. Through studying the expression, clinical significance and the correlation of COX-2 and Survivin protein in the endometrial polyps, we may provide new methods for the diagnosis and treatment of endometrial polyps. If we can develop new kinds of targeted drugs and gene therapy aiming directly at Survivin, and selective COX-2 inhibitors or non-specific inhibitors of the cyclooxygenase with lower side effects, both of which can cure the endometrial polyps effectively,reduce the relapse rate and improve the quality of life, theoretically.If the above theory can be applied in clinical therapy, it may open up a new way for the treatment of endometrial polyps. |
