Expression And Clinical Significance Of Integrin Linked Kinase In Women With Adenomyosis

Objective:Adenomyosis is a common benign gynaecological disorder. It has a predilection to occur in women between 40 and 50 years old whose main symptoms are dysmenorrhea and enlarged uterus. The exact etiology and pathogenesis of this condition remain unclear. Except the radical hystorectomy, no ideal theraputic methods reserved the reproductive function have effctive effects on this disorder. Integrin-linked kinase (ILK) is a multifunctional intracellular serine-threonine protein kinase expressed ubiquitously in mammalian cells. Recently, numerous studies have shown that ILK is aberrantly overexpressed or activated in multiple types of human malignancies. Aberrant expression of active ILK can lead to an acquisition of the cells with more invasive and migratory phenotypes. However, to our kenowledge, there has been no studies reporting the potential role of ILK in adenomyosis. Therefore, it would be worthy of great attention and should be further elucidated. The objective of this thesis is to investigate the expression of ILK in the eutopic and ectopic endometrium of women diagnosed with adenomyosis and appraise the role of ILK in the pathogenesis of endometriosis.Method:The study included 32 patients with histologically proven adenomyosis (adenomyosis group) and 21 patients with leiomyomas or cervical intraepithelial neoplasia (control group). Immunohistochemical SP method was performed to detect the expression of ILK in different parts of the uterus. Assessing the presence and expression level of ILK in both eutopic and ectopic endometrium in adenomyosis, and then compared with the endometrium of control group. At last, we analysed the relationship between the endometrial expression of ILK and the clinical data in patients with adenomyosis.Results:There were no significant differences between groups with regard to age at surgery, age of menarche, age at first birth, menstrual phase, parity, history of pelvic surgery (all P values>.05). Yet women in adenomyosis group tended to have more enlarged uterus and gravidity (both P values<.05). Compared with control group, the proportions of cases suffering from severe dysmenorrhea, menorrhagia, chronic pelvic pain and prolonged menstruation were significantly increased in adenomyosis group (all P values<-05); In the proliferative phase, the expression of ILK in glandular epithelium was significantly higher than that in stromal cells in both adenomyosis and control endometrial samples (all P values<.05). In the secretory phase, there were no significant differences in ILK expression between the glandular epithelium and stromal cells in both eutopic and ectopic endometrium (all P values >.05), whereas the epithelial expression of ILK was statistically significant higher than that in stroma in control endometrium (P=.005); In the proliferative phase, the expression level of ILK in glandular epithelium, as well as in stromal cells, were significantly increased in eutopic endometrium compared with ectopic endometrium (P=.000 and =.009, respectively) and control endometrium (P=.024 and =.001, respectively). Yet in either glandular epithelium or stromal cells, no such significant differences of ILK expression were found between the ectopic and control endometrium (all P values>.05). In secretory phase, no statistically significant differences were found in either epithelial or stromal ILK expression between eutopic and homologous ectopic endometruim (P=.061 and =.069, respectively), or between eutopic and control endometrium (P=.154 and =.056, respectively). Likewise, there were also no significant differences in ILK expression between ectopic and control endometrium in either cell types (P=.577 and =.710, respectively); The epithelial and stromal ILK expression in eutopic endometrium, as well as the stromal ILK expression in control endometrium, were significantly higher in the proliferative phase than that in the secretory phase (P=.026,=.027,=.033, respectively). In contrast, no such cyclic variations were found in either cell types of ectopic endometrium or in epithelial cells of control endometrium (all P values>.05); Dysmenorrhea had a significant correlation with ILK expression both in eutopic endometrial epithelium and stroma (R2=.514, P=.008; R2=.577, P=.019). while there were no correlations between the ILK expression of eutopic endomtrium and age of patients, uterine size, symptom of chronic pelvic pain, the amount of menses and the dutation of menstruation (all P values>.05).Conclusion:The increased expression of ILK in eutopic endometrium suggested that ILK man play roles in the pathogenesis of adenomyosis. The positive correlation between ILK expression of eutopic endometrium and the degree of dysmenorrhea in patients with adenomyosis indicatedd that ILK may be involved in the occurrence and progression of dysmenorrhea in adenomyosis.