The Expression And Significance Of Survivin, Smac And VEGF In Adenomyosis

Objective: To explore the role of Survivin, Smac and VEGF inthe development of adenomyosis and provide an experimental basis for clinicaldiagnosis and treatment of adenomyosis by immunohistochemistry.Methods:38uterus samples were collected from patients withadenomyosis, then the ectopic endometrium (ectopic endometrium group) andeutopic endometrium (eutopic endometrium group) were respectively taken.There were22cases in proliferation phase and16cases in secretory phaseamong of the38samples. Meanwhile20cases of eutopic endometrium (controlendometrium group) were collected from patients whose uteruses weresurgically resected because of other benign tumors. In control endometriumgroup, there were12cases in proliferative phase and8cases in secretory phase.The expression of Survivin, Smac and VEGF in the three groups was detectedby immunohistochemistry assay, and the correlation of each other was analysedby SPSS19.0, and the significant level was defined as P<0.05. The averageoptical density (MOD) in the positive cells was measured by ImagePro6.0professional analysis system.Results:1. The expression of Survivin in the three groups:(1) Theexpression of Survivin in ectopic and eutopic endometrium was significanthigher than that in control endometrium (P<0.05), but there was no difference in ectopic and eutopic endometrium (P>0.05).(2) In ectopic endometrium, theexpression of Survivin in proliferative phase was significant higher than that insecretory phase (P<0.05).(3) In proliferative phase and secretory phase, theexpression of Survivin in ectopic and eutopic endometrium was significanthigher than that in control endometrium (P<0.05).2. The expression of Smac inthe three groups:(1) The expression of Smac was significant difference in thethree groups (P<0.05), and the descending order was control, eutopic andectopic endometrium group.(2) The expression of Smac in the three groups hadnothing to do with menstrual periodicity (P>0.05).(3) In proliferative phaseand secretory phase，the expression of Smac in control endometrium wassignificant higher than that in ectopic and eutopic endometrium (P<0.05).3.The expression of VEGF in the three groups:(1) The expression of VEGF inectopic and eutopic endometrium was significant higher than that in controlendometrium (P<0.05), but there was no difference in ectopic and eutopicendometrium (P>0.05).(2) The expression of VEGF in control and eutopicendometrium was difference along with the changes of menstrual cycle, and theexpression of VEGF was higher in secretory phase than that in proliferativephase (P<0.05).(3) The expression of VEGF in ectopic and eutopicendometrium was significant higher than that in control endometrium both inproliferative phase and secretory phase (P<0.05).4. Correlation:(1) Theexpression of Survivin and Smac was negative correlation in ectopicendometrium(r=-0.815, P<0.05), while they weren’t correlation in control endometrium (r=0.425, P>0.05) and eutopic endometrium(r=0.122, P>0.05).The expression of Survivin and VEGF was positive correlation in ectopicendometrium(r=0.849, P<0.05) and eutopic endometrium(r=0.839, P<0.05),while they weren’t correlation in control endometrium (r=0.410, P>0.05). Theexpression of Smac and VEGF wasn’t correlation in ectopic endometrium(r=0.471, P>0.05), eutopic endometrium (r=0.285, P>0.05) and controlendometrium (r=0.150, P>0.05).Conclusion:1.The expression of Survivin in ectopic and eutopicendometrium was higher than that in control endometrium, which suggestedthat the over-expression of Survivin may play an important role during thedevelopment of the adenomyosis.2. The decreasing tendency of Smacexpression in control, eutopic and ectopic endometrium suggested thatlow-expression of Smac may be lead to the increase of anti-apoptotic abilityand the decrease of pro-apoptotic ability in ectopic endometrium, then furtherpromote the occurrence of adenomyosis.3. There was a negative correlationbetween the expression of Smac and Survivin in ectopic endometrium, whichsuggested that Smac and Survivin may play antagonistic roles in ectopicendometrium．The low-expression of Smac might indirectly or directly causethe over-expression of Survivin and the over-expression of Survivin mightinhibit cell apoptosis and promote the occurrence of adenomyosis.4. Theexpression of Survivin and VEGF was increased in the ectopic and eutopicendometrium of adenomyosis， and there was positive correlation in the expression change. Survivin could suppress the apoptosis of vascularendothelial cell and VEGF could promote the development of vascularendothelial cell, so they may play a synergistic role in the implantation anddevelopment of adenomyosis.