CAJ | 학술논문

目的：探讨左炔诺孕酮宫内缓释系统（LNG-IUS）与他莫西芬引起的子宫内膜病变间的相关性。方法收集2010年10月至2011年7月经病理学证实为浸润性导管癌的术后服用他莫西芬的30例绝经前乳腺癌患者在放置LNG-IUS前后的子宫内膜组织，用real-time PCR和Western blot法检测PTEN、PAX-2、Ki-67和K-ras的表达情况，并在放置LNG-IUS后3、6、12个月行超声随访患者放环前后的子宫内膜情况。结果（1）相比放置LNG-IUS前的子宫内膜厚度[（12.55±2.52）mm]，放置LNG-IUS后子宫内膜3个月[（10.30±1.90）mm，t=12.795，P=0.000]、6个月[（9.10±1.25）mm，t=7.384，P=0.000]、12个月[（7.30±0.87）mm，t＝9.769，P＝0.000]均受到明显抑制；（2）通过对子宫内膜行定量PCR检测发现相较放环前的表达，随着放置LNG-IUS时间延长，PTEN逐渐增高：在放环6个月及12个月时出现统计学差异（t＝-2.401，P＝0.023；t＝-5.579，P＝0.031）；K-ras的表达逐渐降低：在放环12个月时出现统计学差异（t=7.064，P=0.019）；Ki-67的表达逐渐降低：在放置6个月及12个月时出现统计学差异（t＝4.615， P＝0.044；t＝6.817，P＝0.021）；而PAX2的表达虽降低，但无统计学差异；（3）通过Western blot检测亦发现随着放置LNG-IUS的时间延长，PTEN表达增强，在放环6个月及12个月时出现统计学差异（t＝-8.928，P＝0.012；t＝-4.489，P=0.046）；K-ras表达降低：在放环12个月时出现统计学差异（t＝7.965，P＝0.015）；Ki-67的表达降低：在放置6个月及12个月时出现统计学差异（t＝15.600，P=0.004；t＝7.730，P＝0.016），而PAX-2的表达未及明显改变（P＞0.05）。结论 LNG-IUS能降低他莫西芬引起的子宫内膜病变。
목적：탐토좌결낙잉동궁내완석계통（LNG-IUS）여타막서분인기적자궁내막병변간적상관성。방법수집2010년10월지2011년7월경병이학증실위침윤성도관암적술후복용타막서분적30례절경전유선암환자재방치LNG-IUS전후적자궁내막조직，용real-time PCR화Western blot법검측PTEN、PAX-2、Ki-67화K-ras적표체정황，병재방치LNG-IUS후3、6、12개월행초성수방환자방배전후적자궁내막정황。결과（1）상비방치LNG-IUS전적자궁내막후도[（12.55±2.52）mm]，방치LNG-IUS후자궁내막3개월[（10.30±1.90）mm，t=12.795，P=0.000]、6개월[（9.10±1.25）mm，t=7.384，P=0.000]、12개월[（7.30±0.87）mm，t＝9.769，P＝0.000]균수도명현억제；（2）통과대자궁내막행정량PCR검측발현상교방배전적표체，수착방치LNG-IUS시간연장，PTEN축점증고：재방배6개월급12개월시출현통계학차이（t＝-2.401，P＝0.023；t＝-5.579，P＝0.031）；K-ras적표체축점강저：재방배12개월시출현통계학차이（t=7.064，P=0.019）；Ki-67적표체축점강저：재방치6개월급12개월시출현통계학차이（t＝4.615， P＝0.044；t＝6.817，P＝0.021）；이PAX2적표체수강저，단무통계학차이；（3）통과Western blot검측역발현수착방치LNG-IUS적시간연장，PTEN표체증강，재방배6개월급12개월시출현통계학차이（t＝-8.928，P＝0.012；t＝-4.489，P=0.046）；K-ras표체강저：재방배12개월시출현통계학차이（t＝7.965，P＝0.015）；Ki-67적표체강저：재방치6개월급12개월시출현통계학차이（t＝15.600，P=0.004；t＝7.730，P＝0.016），이PAX-2적표체미급명현개변（P＞0.05）。결론 LNG-IUS능강저타막서분인기적자궁내막병변。
Objective To explore the relation between Levonorgestrel-releasing intrauterine system(LNG-IUS) and tamoxifen induced endometrial lesions. Methods Thirty premenopausal breast cancer patients, who had taken tamoxifen as hormonal therapy after undergoing operations from October 2010 to July 2011 and were pathologically diagnosed as invasive ductal carcinoma, were enrolled to place levonorgestrel-releasing intrauterine system. The endometrial tissues of patients before and after placing ING-IUS were collected for detecting expression of PTEN, PAX2, Ki-67 and K-ras by real-time PCR and Western blot. The thickness of endometrium were detected by ultrasound at the point of three, six and twelve months after LNG-IUS was placed. Result (1)The endometrial thickness after LNG-IUS placed was significantly restrained[three months: (10.30±1.90)mm; six months: (9.10±1.25)mm; twelve months: (7.30±0.87)mm]compared to the endometrial thickness[(12.55± 2.52)mm]before LNG-IUS placed (three months: t=12.795, P=0.000; six months: t=7.384, P=0.000; twelve month: t=9.769, P=0.000). (2)By real-time PCR, with LNG-IUS progressing, the expression of PTEN was growing and had statistically differences at the point of six months and twelve point(t=-2.401, P=0.023,t=-5.579, P=0.031);the expression of K-ras was reducing and had difference at the point of twelve months (t=7.064, P=0.019);the expression of Ki-67 was declining and had differences at the point of six months and twelve months (t=4.615, P=0.044 , t=6.817, P=0.021);but expression of PAX2 didn't have any statistically difference though decreased. (3) By immunoblotting, the expression of PTEN was increased and had statistically differences at the point of six months and twelve point (t=-8.928, P=0.012, t=-4.489, P=0.046);that of K-ras was decreased and had difference at the point of twelve months (t=7.965, P=0.015)and Ki-67 was declining and had differences at the point of six months and twelve months (t=15.600, P=0.004,t=7.730, P=0.016); But the expression of PAX-2 was similar(P>0.05). Conclusion Levonorgestrel-releasing intrauterine system lessens the endometrial lesions induced by Tamoxifen.