Preliminary Study On The Mechanism Of The Development Of Endometrial Hyperplasia By Intrauterine Flora

ObjectiveTo explore the composition and diversity of uterine flora in patients with endometrial hyperplasia and healthy people,and to explore the pathogenesis of endometrial hyperplasia from the perspective of flora,and to find specific therapeutic targets for endometrial hyperplasia.Methods1.The diversity and abundance of endometrial tissues from endometrial carcinoma,endometrial hyperplasia and the healthy volunteers were analyzed by 16S rRNA sequencing.2.Flow cytometry was used to detect the levels of Treg cells in endometrial tissues from endometrial carcinoma,endometrial hyperplasia and the healthy volunteers.3.ELISA was used to detect the activity of?-glucuronidase in endometrial tissues from endometrial carcinoma,endometrial hyperplasia and the healthy volunteers,and the level of IL-6 in the uterine flushings fluid of each group.4.Chemiluminescent immunoassay was used to detect the level of E₂ in the uterine flushings fluid of patients with endometrial carcinoma,endometrial hyperplasia and the healthy volunteers.Results1.Normal uterine cavity is not sterile.The relative abundance of Firmicutes?phylum?,Proteobacteria?phylum?and Bacteroidetes?phylum?is significantly higher in the endometrial hyperplasia group than in the healthy volunteer group.At the genus level,higher relative abundance of Bacteroides in the endometrial hyperplasia group,and the relative abundance of Lactobacilli is significantly lower than in the healthy group.At the species level,the relative abundance of Escherichia coli and Bacteroides fragilis was significantly increased in the hyperplasia group.In addition,the relative abundance of Firmicutes and proteobacteria in the endometrial hyperplasia without atypia group was significantly higher than that in the normal group,but it was not significantly different from the atypical hyperplasia group.The relative abundance of Escherichia coli and Bacteroides fragilis was highest in atypical hyperplasia,followed by endometrial hyperplasia without atypia,while the normal group was the lowest.2.The ratio of Treg in endometrial hyperplasia and endometrial carcinomal group was significantly higher than that in healthy group.The?-glucuronidase activity of endometrial tissue and the level of E₂ and IL-6 levels in uterine flushing fluid were higher in the endometrial hyperplasia group and the endometrial carcinomal group than in the healthy group,and the?-glucuronidase activity and E₂ level in the endometrial hyperplasia without atypia group significantly higher than the normal group,but no significant difference with the atypical hyperplasia group.IL-6 levels were highest in the atypical hyperplasia group,followed by endometrial hyperplasia without atypia group,and the normal group was the lowest.Conclusions1.The uterine cavity of normal female is unsterile,and the flora is rich in diversity.2.The relative abundance of Firmicutes and Bacteroides in the intrauterine flora increases,affecting the?-glucuronidase activity of the endometrial tissue,which may affect the local E₂ level of the uterine cavity and participate in the endometrial hyperplasia.Initiation factors of endometrial hyperplasia;at the species level,the relative abundance of Bacteroides_fragilis and Escherichia_coli can affect the secretion of IL-6 inflammatory factors and Treg cell-mediated local immunity in endometrial complex hyperplasia It plays a more important role in atypical hyperplasia and even has a potential role in the pathogenesis of endometrial carcinoma.3.From the perspective of the flora,regulation of the uterine flora may be a new method for the treatment of endometrial hyperplasia.