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目的评估他莫昔芬(TAM)对绝经后妇女子宫内膜的雌激素样作用与性激素受体的改变是否相关,以及细胞增生核抗原Ki-67在子宫内膜中的表达。方法选择46例绝经后因乳腺癌服用TAM超过6个月妇女的子宫内膜为研究组,同时选择18例绝经后妇女的萎缩型子宫内膜作为对照组。采用免疫组织化学法测定雌激素受体(ER)、孕激素受体(PR)及Ki-67在子宫内膜中的表达。结果与对照组比较,PR及Ki-67在TAM组内膜腺上皮细胞呈明显高表达(0.46±0.05比0.35±0.06,P=0.028;15.41±4.83比9.05±5.52,P=0.009);ER在TAM组内膜腺上皮细胞虽然呈高表达,但差异无统计学意义(0.47±0.06比0.43±0.06,P=0.063)。结论绝经后乳腺癌妇女服用TAM后能够引起子宫内膜增生,TAM雌激素样作用与病理诊断和服用时间无关,这可能是子宫内膜息肉及内膜癌的发病机制之一。
Objective To assess whether tamoxifen (TAM) is associated with estrogen-like effects on sex hormone receptors in the endometrium of postmenopausal women and the expression of the cell proliferation progenitor Ki-67 in the endometrium. Methods Forty-six cases of postmenopausal women with breast cancer taking TAM for more than six months were selected as the study group. At the same time, 18 cases of postmenopausal women with atrophic endometrium were selected as the control group. The expression of estrogen receptor (ER), progesterone receptor (PR), and Ki-67 in the endometrium was measured by immunohistochemistry. Results Compared with the control group, PR and Ki-67 were significantly higher in the glandular epithelial cells in the TAM group (0.46±0.05 vs 0.35±0.06, P=0.028; 15.41±4.83 vs 9.05±5.52, P=0.009); ER Although there was a high expression of intimal epithelial cells in the TAM group, the difference was not statistically significant (0.47±0.06 vs 0.43±0.06, P=0.063). Conclusion Postmenopausal women with breast cancer can induce endometrial hyperplasia after taking TAM. The estrogen-like effects of TAM have nothing to do with the pathological diagnosis and the time of taking, which may be one of the pathogenesis of endometrial polyposis and endometrial cancer.