| Objective1.To detect the expression of autophagin Beclin1 and LC3 in eutopic endometrium and ectopic endometrium before treatment,eutopic endometrium and normal proliferative endometrium in patients with adenomyosis treated with local focus resection combined with Gn RH-a and Mirena and analyze their differences.2.To evaluate the value of autophagy protein Beclin1 and LC3 in predicting the efficacy of local focus resection combined with Gn RH-a and Mirena in the treatment of adenomyosis.Methods1.A total of 26 patients with factor 2020.1-2021.12 factor adenomyosis treated in the gynecology department of Qinhuangdao First hospital were treated with laparoscopic or transabdominal adenomyosis,combined with 6cycles of Gn RH-a and Mirena after operation as the case group.The ectopic endometrium and eutopic endometrial tissue were collected before treatment,and the eutopic endometrial tissue was removed at the same time.Among them,the eutopic endometrial tissue of 6 patients who could not get treatment for various reasons were removed,and a total of 20 patients were included in the further study as the case group.20 patients with proliferative endometrium who underwent hysteroscopy at the same time were selected as the control group.Immunohistochemical method was used to detect the expression of Beclin1 and LC3 in eutopic endometrium,ectopic endometrium before treatment,eutopic endometrium after treatment and control group.Chi-square test was used to analyze the difference of Beclin1and LC3 protein expression among the groups.2.The therapeutic effect of this model was analyzed by comparing the changes of uterine volume before operation,1 month,3 months,6 months,9months and 12 months after operation,and the dysmenorrhea score(VAS)and menstrual volume score(PBAC)before operation,after the first menstruation and 12 months after operation.At the same time,the relationship between the expression of autophagy protein Beclin1 and LC3in eutopic endometrium before operation and the changes of uterine volume,dysmenorrhea score(VAS)and menstrual volume score(PBCA)were analyzed.If the quantitative data are in accordance with the normal distribution and the homogeneity of variance is tested by t-test,if it is not consistent,the nonparametric rank sum test is used.Result1.The positive rate of Beclin1 protein expression in ectopic endometrium before treatment,eutopic endometrium before treatment and normal proliferative endometrium in the control group gradually increased,which was 15.00%,40.00%and 90.00%,respectively.There was no significant difference in the positive rate of Beclin1 protein expression in ectopic endometrium and eutopic endometrium before treatment in the case group.The positive rate of LC3 protein expression in ectopic endometrium before treatment,eutopic endometrium before treatment and normal proliferative endometrium in the control group gradually increased,which were 15.00%,45.00%and 95.00%,respectively.2.The positive rates of Beclin1 and LC3 protein expression in eutopic endometrium after treatment in the case group were 80.005%and 85.00%,respectively,which were significantly higher than those in eutopic endometrium before treatment(40.00%and 45.00%).The positive rates of Beclin1 and LC3 protein expression in eutopic endometrium after treatment in the case group and normal proliferative endometrium in the control group were 80.00%,90.00%and 85.00%,95.00%,respectively and the difference was not statistically significant.3.The uterine volumes of patients with adenomyosis treated with local focus resection combined with Gn RH-a and Mirena were 216.12±47.85cm~3,83.93±21.66 cm~3,61.94±17.84 cm~3,54.53±15.58 cm~3,55.74±16.21cm~3 and 58.68±14.20cm~3 before operation,1 month,3 months,6 months,9months and 12 months after operation,respectively.The uterine volume of all patients after operation was smaller than that before operation(P<0.05),and there was no significant difference between 9 months and 6 months after operation,12 months and 3 months after operation,12 months after operation and 9 months after operation(P>0.05).There were significant differences among other groups(P<0.05).4.The dysmenorrhea score(VAS)and menstrual volume score(PBAC)of adenomyosis patients treated with local focus resection combined with Gn RH-a and Mirena were 5.05±0.48,0.40±0.47,0.13±0.44 and 137.00±19.29,30.50±12.87,29.75±12.30 before and 12 months after operation,respectively.The preoperative dysmenorrhea score(VAS)and menstrual volume score(PBAC)were significantly higher than those of the first menstrual recovery and 12 months after operation.There was no significant difference in the first return of menstruation and 12 months after operation(P>0.05).5.In the eutopic endometrium of adenomyosis before treatment,the expression of Beclin1 and or LC3 protein abstractive 3 was positive in 10cases and negative in 10 cases.The difference of uterine volume and menstrual volume score(PBAC)in adenomyosis patients with positive expression of Beclin1 and or LC3 protein before and 12 months after operation were 136.83±46.15cm3 and 91.00±18.97respectively,which were lower than 178.06±38.17cm3 and 109.50±16.41in patients with both negative expression.However,the difference of dysmenorrhea score(VAS)between the two groups before operation and 12 months after operation was4.95±0.24,4.75±0.82respectively.Conclusion1.The positive rates of LC3 and Beclin1 proteins in normal proliferative endometrium and eutopic endometrium after treatment were higher than those in ectopic endometrium before treatment,suggesting that downregulation of Beclin1 and LC3 may be involved in the pathogenesis of adenomyosis.2.Local focus resection combined with Gn RH-a and Mirena in the treatment of adenomyosis can effectively reduce the volume of uterus,improve the symptoms of dysmenorrhea and reduce the amount of menstruation.This model has certain application value in the treatment of adenomyosis.In patients with negative expression of autophagy protein Beclin1 and LC3 in eutopic endometrium before treatment,the therapeutic effect may be better. |
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