| Objective:1 To study the different role and relationship between mitochondrial proapoptotic factor Smac(second mitochondrial activator of caspase,Smac) and XIAP(X-linked inhibitor of apoptosis protein,XIAP) of endometrium with non endometriosis(EMs),eutopic endometrium and ectopic endometrium with ovario-EMs.To discuss the role apoptosis play in the development of EMs.2 To observe the levels of tumor necrosis factor- alpha (TNF-α) in peritoneal fluid of endometrium with non endometriosis(EMs),eutopic endometrium and ectopic endometrium with ovario-Ems.To discuss the role,which the change of physico-chemical property in peritoneal fluid play in the genius morbi of endometriosis.3 To discuss the importance of apoptosis in the mechanism of endometriosis(EMs),which is defined as a benign disease with malignant behaviour by analysising the relatioship between XIAP,Smac and TNF-αin EMs.Methods:1 Study object:①study group:from February 2007 to April 2008,we collected eutopic endometrium and ectopic endometrium in 80 patients who were suffering from endometriosis,and the stages wereⅢorⅣaccording to rAFS. Among them,there were 48 cases in stageⅢ,32 cases inⅣ;40 cases in proliferative phase,40 cases in secretor phase.Peritoneal fluid of 72 cases were collected,36 cases in proliferative phase,36 cases in secretory phase,40 cases in stageⅢ,32 cases inⅣ.②control group:eutopic endometrium, ectopic endometrium and peritoneal fluid from 55 infertilize women duing to ductus Mueller obstrucal who treated by laparoscopic operation during February 2007 to April 2008. There were 30 cases in proliferative phase,25 cases in secretory phase.The average ages among two groups was no difference.And all cases were not taking hormone drugs in 3 month,not suffering from other diseases.2 The expressions and relationship of XIAP and Smac in normal endometrium,eutopic endometrium and ectopic endometrium had been examined by immunohistochemical assay.3 TNF-αin peritoneal fluid of non endometriosis(EMs) and ovario-Ems,had been test by ELISA.Results:1 XIAP:The expression of XIAP was located in endochylemain of cellula epithelialis and mesenchymal cell of endometrium.①In menstrual cycle,The expression of XIAP in eutopic endometrium and in ectopic endometrium is stronger than in control(p＜0.05),but there has non-significance difference(p＞0.05).②The expression of XIAP in proliferative stage was significant higher than secretory stage,no matter in endometrium of control group and the eutopic endometrium of study group(p＜0.05).But XIAP in ectopic endometrium,there was no significant between proliferative stage and secretory stage(p＞0.05).③In proliferative stage the expression of XIAP in endometrium of control group was weaker than that in eutopic endometrium and ectopic endometrium(p＜0.05). There were no different of expression of XIAP between eutopic endometrium and ectopic endometrium in proliferative stage(p＞0.05).④In secretory stage,there were differences of the expression of XIAP among any two group of control endometrium,eutopic endometrium and ectopic endometrium (p＜0.05).ectopic endometrium is the strongest,control endometrium is the weakest.⑤The expression of XIAP in eutopic endometrium of rAFS-Ⅲand rAFS-Ⅳ,there were no difference in menstrual cycle.(p＞0.05).The expression of XIAP in ectopic endometrium of rAFS-Ⅲand rAFS-Ⅳ,there were no difference in menstrual cycle also(p＞0.05).2 Smac:The expression of Smac was located in endochylemain of cellula epithelialis and mesenchymal cell of endometrium.①In menstrual cycle,The expression of Smac in eutopic endometrium and in ectopic endometrium is stronger than in control(p＜0.05),but there has non-significance difference(p＞0.05).②The expression of Smac in secretory stage was significant higher than proliferative stage,no matter in endometrium of control group and the eutopic endometrium of study group(p＜0.05).But Smac in ectopic endometrium, there was no significant between proliferative stage and secretory stage(p＞0.05).③In proliferative stage there were differences of the expression of Smac among any two group of control endometrium,eutopic endometrium and ectopic endometrium(p＜0.05).ectopic endometrium is the strongest, control endometrium is the weakest.④In secretory stage,the expression of Smac in endometrium of control group was weaker than that in eutopic endometrium and ectopic endometrium(p＜0.05).There were no different of expression of Smac between eutopic endometrium and ectopic endometrium in secretory stage(p＞0.05).⑤The expression of Smac in eutopic endometrium of rAFS-Ⅲand rAFS-Ⅳ,there were no difference in menstrual cycle.(p＞0.05).The expression of Smac in ectopic endometrium of rAFS-Ⅲand rAFS-Ⅳ,there were no difference in menstrual cycle also (p＞0.05).⑥The correlation between XIAP and Smac:There were positive correlations between proliferative stage and secretory stage in control endometrium and eutopic endometrium and ectopic endometrium(p＜0.05).3 TNF-αIn both control group and rAFS-Ⅲ,rAFS-Ⅳof study group,there was no significant difference of TNF-αin peritoneal fluid in menstrual cycle.In proliferative stage,there level of TNF-αin peritoneal fluid of rAFS-Ⅲ,rAFS-Ⅳstage were higher than control group(p＜0.05).While there was not different between rAFS-Ⅲstage and rAFS-Ⅳstage (p＞0.05).And there has no difference between proliferative stage and secretory stage. 4 The correlation between Smac in endometrium and TNF-αin peritoneal fluid has positive relationship(p＜0.05),it has statistics significance.Conclusion:In endometriosis,the increased expression of XIAP was benefited for locally and distantly metastatic of ectopic endometrium.While overexpress of Smac restricted the growth of ectopic endometrium unlimited.So endometriosis is a benign disease.At the same time,from this experiment we can know in endometriosis the exprssion of TNF-αis higher than in control.TNF-αby activating caspase cascade to promote the target cell apoptosis.In a certain extent, also inhibit excessive XIAP expression.
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