| Objective:Endometriosis(EM)is a common disease defined as the growth of endometrial tissue(glands and stroma) outside the uterine cavity that often results in a vast array of gynecological problems including dysmenorrhe,pelvic pain and infertility.EM is a commonly and frequently encountered gynecological disease. Recently,much attention has been focused on the role of angiogenic factors on the pathogenesis of endometriosis. The aim of this experiment is to investigate the expression of VEGF,HIF-1α,MVD,ER,PR in EM and the content of VEGF,E2,P,CA125 in serum and peritoneal fluid , in order to reveal the relationships between angiogenesis and EM, also we analyzed the changes of pretreatment and post-treatment by tonifying kidney warming yang removing blood stasis method in order to disproof the relationship between angiogenesis and EM. Also we hope to provide new method for the treatment of EM.Methods:Sixty patients who fitted the diagnostic standard, included standard, excluded standard and traditional Chinese medicine standard in differentiation of symptoms and signs of EM coming from the fourth hospital of city Shijiazhuang during October 2005 to Decemberr 2006 were collected.Thirty cases were treated by the tonifying kidney warming yang removing blood stasis method for three menstrual cycles.The other thirty cases were treated by Gestrinone.During the observed course,the patients did not take any other herb or western drug.we collected blood from ulnar vein in pretherapy and posttherapy during the same time of the menstrual cycle(the day 5～10). 30 voluntary subjects were selected as serum control group eliminating disease in heart, kidney or endocrine system etc.We collect 30 cases with endometriosis called EM group ,and 30 cases with myoma of uterus called control group, peritoneal fluid,eutopic endometrium,ectopic endometrium and normal endometrium were collected while operating, diagnosis was confirmed by pathological examination. Immuno-histochemical staining was used to detect VEGF,HIF-1α,MVD,ER,PR expression in different parts of the uterus,detected the contents of VEGF,E2,P,CA125 in serum and peritoneal fluid by means of radio immunoassay or enzyme linked immunosorbent assay. Since the control group cases had no significant difference with the patients in age, they were comparable.Result:1 The expression of VEGF,HIF-1α,MVD,ER,PR in endometriosis1.1 Expression of VEGF in endometriosis Compared with control group, the expression of VEGF in eutopic and ectopic endometrium significantly increased (all P<0.01), there was no statistical differences between eutopic endometrium and ectopic endometrium(P>0.05).1.2 Expression of HIF-1αin endometriosisCompared with control group, the expression of HIF-1αin eutopic and ectopic endometrium significantly increased(all P< 0.01),there was no statistical differences between eutopic endometrium and ectopic endometrium(P>0.05).1.3 Expression of MVD in endometriosisCompared with control group, the expression of MVD in eutopic and ectopic endometrium significantly increased(all P<0.01),there was no statistical differences between eutopic endometrium and ectopic endometrium(P>0.05).1.4 Expression of ER,PR in endometriosisThe expression of ER and PR in ectopic endometrium was significantly lower than that of control endometrium(all P<0.01),there was no significant differences between eutopic endometrium and control endometrium(all P>0.05).The expre- ssion of ER and PR in ectopic endometrium was lower than that in eutopic endometrium(all P<0.01),compared to the control endometrium,there was no significant differences. 1.5 The correlation among VEGF,HIF-1αand MVD in endometriosisThe study result indicated that there was positive correlation between MVD and VEGF in eutopic endometrium,ectopic endometrium (r=0.510,r=0.673,P<0.05,P<0.01),there was positive correlation between MVD and HIF-1αin eutopic endometrium,ectopic endometrium (r=0.559,r= 0.435, P<0.01,P<0.05),there was positive correlation between HIF-1αand VEGF in eutopic endometrium,ectopic endometrium (r=0.492,r=0.695,P<0.05,P<0.01).2 The content of E2,P,VEGF,CA125 in peritoneal fluid The level of E2 in peritoneal fluid was higer in EM group than in control group(P<0.05); The level of P in peritoneal fluid was lower in EM group than in control group(P<0.01); The level of VEGF in peritoneal fluid was higer in EM group than in control group (P<0.05); The level of CA125 in peritoneal fluid was higer in EM group than in control group(P<0.05).3 The observation of the curative effect and the changes of serum E2,P,VEGF,CA125 before and after treated by tonifying kidney warming yang removing blood stasis method3.1 The observation of the curative effect by tonifying kidney warming yang removing blood stasis method 30 patients with Endometriosis were treated by tonifying kidney warming yang removing blood stasis method. After treating,7 cases(22.86%)were healed,9 cases(28.57%) were excellent, 6 cases(25.71%)were effective and 8 cases(22.92%) were invalid. The total effective rate was 73.33%.3.2 The changes of serum E2,P,VEGF,CA125 before and after treated by tonifying kidney warming yang removing blood stasis methodAfter treated by tonifying kidney warming yang removing blood stasis method,compared with pre-T group, the level of serum E2 in post-T group was significantly decreased (P<0.01),with no statistical difference compared to control group(P>0.05), the level of serum P in post-T group was significantly increased (P<0.01),with no statistical difference compared to control group(P>0.05),the level of serum VEGF in post-T group was significantly decreased (P<0.01),with no statistical difference compared to control group (P>0.05),the level of serum CA125 in post-T group was significantly decreased (P<0.01),but still there were statistical differences compared to control group(P<0.01).Conclusion: Our studies demonstrates that the pathogene- sis and activity of endometriosis possibly depend of internal angiogenesis,the overexpression of VEGF and HIF-1αin endometriosis have a significant relation with angiogenesis,may play an important role in pathogenesis of endometriosis.The contents of VEGF,CA125,E2,P in EM are significant differently compared to control group,indicate that there are intimate relation among angiogenesis,sexual hormone and EM.Our study show that the tonifying kidney warming yang removing blood stasis method can cure endometriosis by decreasing the level of VEGF,regulating sexual hormone. |
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