Correlation Study On The Expression Of Endometrial Estrogen Receptor?progesterone Receptor And Hormone Treatment In The Prognosis Of Intrauterine Adhesions

Research backgroundIntrauterine adhesions(IUAs)refers to intrauterine traumas caused by endometrial injury,and subsequent complications such as menstruation,amenorrhea,periodic abdominal pain and fertility.Trans-Cervical Resection of Adhesions(TCRA)by hysteroscopy has become the standard procedure for the treatment of IUAs.However,postoperative recurrence of adhesions has become one of the challenges of clinicians.Supplemental estrogen is considered to be an important part of IUAs comprehensive treatment,but many scholars have different opinion of the efficacy of the estrogen on IUAs and there is no consensus on the application of dose.Studies have shown that insufficient or dysfunctional estrogen receptor(ER)and progesterone receptor(PR)of the endometrium can affect the growth of endometrium thus correlate with the prognosis of development of IUAs.Therefore,this study is to compare the differences in the expression of ER,PR of emdoometrium of the normal women and different degrees of IUAs patients who are at the childbearing age and to explore the correlation between the incidence and the prognosis of IUAs and the expression of ER and PR.To provide a theoretical basis of the clinical efficacy and ER,PR expression changes of IUAs patients who undergo TCRA and postoperative estrogen intake.Research Method1.Research subjectsThis study collected the clinical data of patients with uterine intrauterine adhesions and normal control subjects from July 2012 to May 2016 in Zhujiang Hospital of Southern Medical University and Shenzhen Eighth People's Hospital.The subjects were women of childbearing age between 18 to 40 years old.The normal control group contains 43 cases of patinets with cervical intraepithelial neoplasia and infertile due to tubal factor.37 cases of mild,35 case of moderate and 50 cases of severe IUAS patients who were accessed according the American Fertility Standard involved in this study.2.Therapeutic ScheduleEndometrium of each subject was taken off during the first hysteroscopic surgery Patients with IUAS were placed the circular intrauterine device wrapped with Interceed in the uterine cavity.Estrogen intake which lasts 21 days in each period therapy began on the fifth day of the srugery and progestrone intake began on the twelfth day of estrogen intake and this periodical treatment lasts 3 months.Mild group were given small dose of estrogen treatment,moderate group and severe group were given mmoderate or large dose of estrogen treatment.Small dose of estrogen refers to 2 to 3mg progynova daily,once a day,the middle dose of estrogen refers to 6mg progynova daily and high dose of estrogen refers to 10mg daily.In the normal control group,a small amount of endometrium was taken during the operation.3.Therapeutic effect evaluationOutpatient follow-ups made records of the menstrual flow of patients with IUAS during the therapeutic period.The second look hysteroscopy was conducted in the third hormone therapeutic period.AFS scores were recorded and some endometrium was also taken during the surgery.4.Endometrium tissue testingHE staining and ERa and PRA immunohistochemical staining were performed in endometrial specimens.The images were analyzed with Image Proplus software to rcalculate cumulative optical density values so as to eflect the expression of ER and PR.Result1.the expression of ER and PRThe expression of ER and PR in the gland and stroma of the endometrium was similar between the normal group and the mild group(P>0.05),the moderate group was lower than the normal group,the severe group shows the lowest expression of ER and PR and the differences are statistically significant(P<0.05).The AFS scores were lower than those in the first look hysteroscopy and the expression of ER and PR were significantly increased(P<0.05).In the mild and moderate groups,the expression of ER and PR was not significantly different after treatment with different doses of estrogen.The high dose estrogen group shows significantly higher expression of ER and PR than that in the middle dose group in sereve group and the difference was statistically significant(P<0.05).2.Efficacy of different doses of extrogenThe AFS scores of the three groups of IUAS patients are statistically significant lower in the second look hysteroscopy than in the primary surgery(P<0.05).There is no significant difference of AFS score between small dose and moderate dose in mild group(P>0.05).There is either no significant difference of AFS score between moderate dose and large dose in moderate group(P>0.05).The AFS scores of large dose estrogen treatment are significantly lower than moderate dose group in severe group(P<0.05).Conclusion1.ER and PR in IUAS patients were lower than those in normal control group,and the expression of ER and PR decreased with the severity of IUAs increasing,whichindicate that the low expression of ER and PR may be involved in the progression of IUAs.2.Estrogen and progesterone sequential therapy combined with TCRA and circular intrauterine dvice wrapped with interceed placed in the uterine cavity,can effectively reduce the degree of IUAs.Especially for patients with severe IUAs,TCRA combined with large-dose estrogen therapy has a better clinical improvement rate.3.The expression of ER and PR in endometrium of IUAs patients in second look hysteroscopy is significantly higher than that in the fisrt look hysteroscopy,and the expression of ER and PR was negatively correlated with AFS score,suggesting that estrogen and progesterone therapy may promote the expression of ER and PR to improve the prognosis of IUAs.