Estrogen receptor-α immunoreactivity predicts symptom severity and pain recurrence in deep endometriosis
Estrogen receptor-α immunoreactivity predicts symptom severity and pain recurrence in deep endometriosis
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DOI：
10.1016/j.fertnstert.2020.01.036
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发表时间：
2020-06-01
影响因子：
6.7
通讯作者：
Taylor, Hugh S.
中科院分区：
文献类型：
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作者：
Pluchino, Nicola;Mamillapalli, Ramanaiah;Taylor, Hugh S.
目的：确定子宫内膜异位症中类固醇受体表达与疼痛症状之间的关系。设计：横断面设置：大学医院患者：患有子宫内膜异位症的女性 (N = 92)。干预措施：从手术诊断的子宫内膜异位症患者中获取组织样本。主要结果指标：从子宫内膜异位症患者中生成组织微阵列 (TMA)。在手术时和 1 年后使用数字评定量表 (NRS) 收集痛经、深度性交痛、便痛和非经期疼痛的存在和严重程度的数据。通过免疫组织化学评估受体表达的强度，并根据免疫反应评分（IRS）进行测量。通过多变量逻辑回归分析将临床变量与 IRS 相关。结果：雌激素受体-α (ER-α)、孕激素受体 (PR)、雄激素受体 (AR) 和芳香酶表达在研究参与者之间存在差异。孕激素治疗降低了 ER-α 的表达，而 PR、AR 和芳香酶的表达则没有变化。较高的 ER-α 表达增加了未接受激素治疗的女性出现中度至重度痛经和深度性交痛的可能性。在接受孕激素治疗的女性中，持续较高的 ER-α 表达与 1 年深部性交困难、严重排便困难和子宫内膜异位症相关疼痛持续性的可能性更大相关。结论：ER-α、PR、AR 和芳香酶均在深部子宫内膜异位症中表达。 ER-α 水平与症状的严重程度最相关，这表明 ER 是深部子宫内膜异位症的关键驱动因素。孕激素治疗与 ER-α 表达减少有关；然而，孕激素未能抑制 ER 也是 1 年疼痛严重程度和复发的预测因素。 （(C) 2020 年，美国生殖医学会。）
Objective: To determine the relationship between steroid receptor expression and pain symptoms in endometriosis.Design: Cross-sectional Setting: University HospitalPatient(s): Women with endometriosis (N = 92).Intervention(s): Tissue samples were obtained from patients with surgically diagnosed endometriosis.Main Outcome Measure(s): A tissue microarray (TMA) was generated from patients with endometriosis. Data were collected on the presence and severity of dysmenorrhea, deep dyspareunia, dyschezia, and nonmenstrual pain by use of a numerical rating scale (NRS) at the time of surgery and after 1 year. The intensity of receptor expression was evaluated through immunohistochemistry and measured according to an immunoreactive score (IRS). Clinical variables were correlated to IRS by multivariate logistic regression analysis.Results: Estrogen receptor-alpha (ER-alpha), progesterone receptor (PR), androgen receptor (AR), and aromatase expression differed among study participants. ER-alpha expression was reduced by progestin therapy, whereas of expressions of PR, AR, and aromatase were unchanged. Higher ER-alpha expression increased the likelihood of moderate to severe dysmenorrhea and deep dyspareunia in women not receiving hormonal treatment. In women receiving progestin therapy, persistently higher ER-alpha expression was correlated with greater likelihood of deep dyspareunia, severe dyschezia, and endometriosis-associated pain persistence at 1 year.Conclusion(s): ER-alpha, PR, AR, and aromatase were all expressed in deep endometriosis. ER-alpha levels best correlated with severity of symptoms, which suggests that ER is a key driver of deep endometriosis. Progestin treatment was associated with a reduction of ER-alpha expression; however, failure of ER suppression by progestins was also a predictor of pain severity and recurrence at 1 year. ((C) 2020 by American Society for Reproductive Medicine.)