Expression Of CTGF, Integrin-β1, ER, PR In Infertile Patients With Endometrial Polyps

Background:Endometrial polyps was a common lesions of the endometrium and had a high detection rate in infertile women.Cutting the endomerrium by hysteroscopic could improve women's reproductive function of infertility and increase the success rate of assisted reproductive technology.Endometrial polyps was a benign monoclonal dissease which formed by proliferation of mesenchymal tissue.In morphology organization,EP composited with glands and interstitial which included fibrosis that was focal at least and thick blood vessels.The factor CTGF,Integrin,ER and PR played an important role in cyclical changes in the endometrium or pregnancy.CTGF exists in the normal uterus of women who is reproductive age and changes with the cyclical endometrial changes.It invoves in uterine growth,migration,adhesion,early embryonic development,and so on. Integrins is a class of cell adhesion molecules, existes in the cell surface.At present,integrins have been a recognized indication in the measure of endometrial receptivity.The content of ER, PR in endometrial changes cyclically in the menstrual cycle.They are regulated movement with estrogen and progesterone cyclical change,endometrial ER,PR levels remained within the normal range,and adapted to different states endometrial menstrual cycle.There has some researches shown that,CTGF is a type of factor which highly express in fibrotic diseases.It is a closely related to proliferative and fibrotic diseases.Integrins is one of the auxiliary receptor of CTGF and has a common receptor site with CTGF.CTGF can promote in a dose dependent manner to increase the expression of integrins.Then integrins greatly improve the adhesion of signal in local micro-environment,and further promoting fibroblast activation and proliferation, secrete CTGF, thereby enhancing the effect in repairing matrix of CTGF.Currently,the correlation between infertility patients with endometrial polyps and CTGF, integrin,ER,PR expression has not been reported.Objective:This study was designed to observe the expression of ER, PR,CTGF and integrin-β1 in proliferative of endometrial polyps which was derived by the hysteroscopy in infertile patients.Discussion the receptivity changesand possible mechanisms in EP.Method:1 Research objectThe cases used to investigate with complete clinical information were collected from patients diagnosed from 2010 to 2011 at the Second Hospital of HeBei Medical University.46 cases in study group were selected from irregular menstruation and infertile patients,age range was 20 ~ 40 years old. After vaginal ultrasound examination, EP tissues were performed under hysterosound . All the examination was performed after menstrual clean in one week. All polyp cases were confirmed by pathology. All the selected cases were excepted for taking any nonsteroidal hormone within three months.Control group,21 cases of normal proliferation endometrium,were selected from tubal infertility,age range was 20 ~ 40 years old,except those of any other uterine lesions.2 Immunohistochemical stainingThe protein expression of ER,PR,CTGF,Integrin-β1 in all cases were detected with immunohistochemisty S-P two-step.The procession was carried out acccording to manufacturer's instructions.Hematoxylin stsining, grad alcohol dehydration,dimethyl benzene transparence,neutral gum mounting,observel under light microscope.3 Statistical analysisThe experimental data were anlyzed with Wilcoxon rank sum test, Spearman correlation analysis with stastics software of SPSS17.0 edition. Results:1 The protein expression of ER,PR in the endometrial polyps ER,PR expression located in the nucleus of glandular epithelial cells and stromal cells.In endometrial polyps,ER,PR were positive in the glandular epithelial cells expressed,no negative.In stromal cells,ER positive expression rate was 97.83%(45/46),1(+++),23(++),13(+),1(-).PR positive expression rate was 93.48%(43/46),1(+++),20(++),20(+),3(-).The expression of ER in glands was no significant statistical difference between EP and normal proliferative phase endometrium(P>0.05),and PR was same too(P>0.05).In stromal,expression of ER,PR have statistically significant (P<0.05),In polyps,the ER, PR expression was significantly lower than the control group(P<0.05).2 The protein expression of CTGF in the endometrial polypsCTGF positive signal was brown, located in the cytoplasm.CTGF positive expression rate in normal proliferative phase endometrium stromal was 61.9%(13/21),8(-),13(+),and in EP was 91.3%(42/46),4(-),19(+),19(++),4(+++).One control group was lower than the expression of CTGF positive endometrial polyp group,the difference was statistically significant (P <0.05) .3 The protein expression of Integrin-β1 in the endometrial polypsIntegrin-β1 protein expression mainly localized in the cytoplasm,some of the membrane color, is light yellow to brown-yellow granules,the nucleus almost no color.Integrin-β1 positive expression rate in normal proliferative endometrium was 61.9%(13/21),8(-),12(+),1(++),and in EP was 100%(46/46),19(+), 22(++),5(+++).Integrinβ-1 control group was lower than the positive expression of endometrial polyp group,the difference was statistically significant(P <0.05).4 Relationship among ER,PR,CTGF and Integrin-β1 expression in endometrial polyp The relevant statistics was found in endometrial polyps that expression of ER and PR in the stroma of EP was positively correlated;CTGF and Integrin-β1 were positively correlated.There was no correlation between ER, PR and CTGF,Integrin-β1.Conclusion:1 Comparing with the normal proliferative endometriu,the expression of ER, PR decreased in stromal of endometrial polyps,and had a positive correlation between them.It prompted us that the receptor-negative cells which was expressed in EP were relatively insensitive to the cyclical changes in hormones.2 Patients with endometrial polyps in infertile Integrin-β1 expression increased, suggesting that infertility may be related to the disturbance of the expression of phase advance.3 Comparing with the normal proliferative endometriu,the expression of CTGF increased in endometrial polyps,and had a positive correlation between CTGF and .Integrin-β1.It prompted us that CTGF play a role in the Process of promoting interstitial fibrosis in endometrial polyps.4 There was no relationship between CTGF,Integrin-β1and ER,PR.At present,it did't have prompted that there had relationship between the highly expression by CTGF,Integrin-β1and decreased expression by ER and PR in polyps.