| Objective:Endometriosis is common disease among women of reproductive age .In recent years, its incidence has a clear upward trend.The pathogenesis of the disease has not been fully clarified as yet .Although endometriosis belongs to benign disease, but it has the biological malignant behavior.Hypoxia is a common phenomenon in the development of malignant tumors. The research aims at studying topic is the correlation between hypoxia and endometriosis to explore endometriosis pathogenesis. On the basis of pre-treatment that the method of tonifying kidney warming yang and removing blood stasis has good effect, We furtherly study the effect of Bushen wenyang Huayu method on Hypoxic status in the EMs model rats, to reveal Chinese medicine treatment of EMs part of the role of the mechanism.Methods:1 Clincial observation:Study Group: Twenty-four patients who fitted included standard, coming from Baiqiuen International Peace Hospital,The fourth hospital of city Shijiazhuang,Hebei province chinese medicine hospital during October 2007 to December 2008 were collected. All cases were confirmed by laparoscopy or laparotomy operation.Peritoneal patients were eight cases, Ovarian endometriotic cyst patients were seven cases, adenomyosis patients were nine cases.Respectively, ectopic endometrial tissue collected in the course of surgery, Pathological specimens confirmed to be ectopic endometrial.control group: Chose patients with uterine leiomyoma and normal endometrial the same period of hospital, pathologically confirmed to be normal endometrium. All patients were informed consent,comparison of the distribution of age in each group balanced, no statistical difference, they were comparable. Observation Project:Immun- ohistochemical streptavidin-biotin-protein-Links peroxidase method (SP method) to determinate the expression of HIF-1, CD34, CD54 in endometriosis group and control group .2 Animal Experiments:80 depuratory and healthy wister females rats with normal strous cycle,200±20g in body weight,24 are divided into normal group and sham-operated group(each group is 12),others are used wangyanping method to duplicate the model of endometriosis. After 4 weeks,chose the rats that duplicate model triumphantly and divided them into 4 group:low-dose group,high-dose group,Danazol group,model group. There were 10 rats in each group. Those rats of low dose and high dose groups were administrated in dose of 15.41g/kg,61.76g/kg separately,once per day for 4 weeks. The rats of Danazol group were in dose of 100mg once daily. Model group, sham-operated group and normal group were given the same voluminal distilled water. Fasting eight hours after last administration, sacrificed the rats by decapitation during anestrum. Disseced and got rats endometrium quickly,slighlty wiped with filter paper.Fixed endometrium in 4%Polyoxymethylene,paraffin embedded,slice in 5μm. Carried out immunohistochemical staining, Determination the expression of HIF-1,CD34,CD54 in endometrial tissue; At the same time ,Check another part of the Organization add liquid nitrogen to preserve cans quickly,determine the expression of FIH-1in endometriosis.Results:1 Clincical observation:HIF-1αexpressed in peritoneal endometriosis, chocolate cyst and adenomyosis, mainy ectopic endometrial and stromal .The expressed intensity from low to high were adenomyosis, chocolate cyst, peritoneal endometriosis. But there were no significant difference among there groups (P>0.05).In study group the expression of HIF-1αhigher than control group significantly, There was a significant difference between the two groups(P<0.05);CD34 has expressed in study group, The expressed intensity from low to high were peritoneal endometriosis ,chocolate cyst, adenomyosis, But there were no significant difference among there groups (P>0.05),In study group the expression of CD34 higher than control group significantly, There was a significant difference between the two groups(P<0.05); CD54 has expressed in study group, The expressed intensity from low to high were chocolate cyst, adenomyosis, peritoneal endometriosis.But there were no significant difference among there groups(P>0.05),In study group the expression of CD54 higher than control group significantly, There was a significant difference between the two groups(P<0.05).There were positive correlation between expression of HIF-1αand activation of CD34 in peritoneal endometrium tissue(r=0.873,P=0.01);the expression of HIF-1αand CD34 had a positive correlation in peritoneal endometrium tissue(r=0.857,P=0.01).2 Animal experiment indicate:Positive expression of HIF-1α, in the ectopic endometrial glandular epithelium transplantation,and the cytoplasm of stromal mainly, model group was higher than normal group, There was significant differences between the two groups (P<0.05), model group was higher than sham-operated group, There was significant differences between the two groups(P<0.05), high -dose group ,low-dose group were lower than model group, the two groups had significant differences with model group(P<0.05), high -dose group ,low-dose and normal group had no difference (P>0.05), high -dose group lower than western medicine group, there was significant differences between the two groups(P<0.05), high -dose group and low-dose had no significant difference(P<0.05), low-dose and western medicine group had no difference (P<0.05). Positive expression of CD34 in the heterotopic transplant organization in the interstitial mainly, model group was higher than normal group, There was significant differences between the two groups (P<0.05), model group was higher than sham-operated group, There was significant differences between the two groups(P<0.05), high -dose group ,low-dose group were lower than model group, there was significant differences between the two groups(P<0.05), high -dose group ,low-dose and normal group had no difference (P>0.05).There had no difference among high-dose group,low-dose and western medicine group. Positive expression of CD54 in Heterotopic transplant organizations glandular epithelium mainly, model group was higher than normal group, There was significant differences between the two groups(P<0.05), model group was higher than sham-operated group, There was significant differences between the two groups(P<0.05), high -dose group ,low-dose group were lower than model group, there was significant differences between the two groups(P<0.05), high -dose group ,low-dose and normal group had no difference (P>0.05)), high -dose group lower than western medicine group, there was significant differences between the two groups(P<0.05), high -dose group and low-dose had no significant difference(P>0.05), low-dose and western medicine group had no difference (P>0.05). The expression of FIH-1 in model group was higher than normal group, There was significant differences between the two groups (P<0.05), model group was higher than sham-operated group, There was significant differences between the two groups (P<0.05), high -dose group ,low-dose group were lower than model group, there was significant differences between the two groups(P<0.05), high -dose group ,low-dose and normal group had no difference (P>0.05), There had no difference among high -dose group ,low-dose and western medicine group.Conclusions:1 This study showed that HIF-1α,CD34,CD54 expressed in ectopic endometrial and stromal among endometriosis,chocolate cyst and adenomyosis, HIF-1α'sexpression plays an important role in the formation of endometriosis,maybe it is an important aspect in the occurrence and development of endometriosis, suggest that endometriosis is closely related to the occurrence of hypoxia.2 There has a positive correlation between HIF-1αand CD34, show that HIF-1αcan promote angiogenesis in peritoneal endometriosis. There has a positive correlation between HIF-1αand CD54, HIF-1αthat can enhance the adhesion of endometriotic cells and thus is conducive to the formation of ectopic lesions.3 Animals were treated by Bushenwenyanghuayu chinese medicine,reduced endometrial tissue transplantation significantly.At the same time, it can reduce the expression level of HIF-1α,CD34,CD54,. tonifying kidney warming yang removing blood stasis method plays a role in treatment of endometriosis.4 The expression of FIH-1 in endometriosis model group lower than the normal group and sham -operated group, May be associated with endometriosis by inhibiting the expression of hypoxia-related. This to be further studied.
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