张莉 汪霆(等)

[摘要] 目的 探讨FUT4和LeY在子宫内膜异位症患者中的表达情况及其临床价值。 方法 选择2010年3月～2012年6月辽宁省大连市妇幼保健院（以下简称“我院”）妇产科经腹腔镜手术证实为子宫内膜异位症的70例患者，将患者分为在位内膜组和异位内膜组，每组各35例。同时选择同期我院行手术治疗的单纯子宫肌瘤患者35例为对照组。采用免疫组化、RT-PCR检测三组患者子宫内膜组织中FUT4和LeY的表达情况，并对其变化的意义进行评价和分析。 结果 ①与对照组比较，在位内膜组和异位内膜组患者的FUT4阳性表达率均明显提高，差异有统计学意义（P < 0.05），异位内膜组FUT4的阳性表达率高于在位内膜组（P < 0.05）；②与对照组比较，在位内膜组和异位内膜组患者的LeY的阳性表达率均明显提高，差异有统计学意义（P < 0.05），异位内膜组LeY的阳性表达率高于在位内膜组，差异有统计学意义（P < 0.05）；③与对照组比较，FUT4在异位内膜组和在位内膜组中的阳性表达率明显高于对照组，差异有统计学意义（P < 0.05），异位内膜组FUT4的阳性表达率高于在位内膜组（P < 0.05）。 结论 FUT4和LeY不仅在子宫内膜异位症的形成和发展过程中发挥着重要作用，其在胚胎黏附、植入过程中也起着重要作用，而FUT4是LeY合成的关键酶，当其表达量高于某一临界值时，会诱发子宫内膜异位症，影响胚胎的正常着床，从而进一步导致不孕。

[关键词] 子宫内膜异位症；子宫内膜；FUT4；LeY

[中图分类号] R711.71 [文献标识码] A [文章编号] 1673-7210（2014）10（b）-0038-05

Expression of fucosyltransferase 4 and Lewis Y in endometriosis and its clinical significance

ZHANG Li1 WANG Ting1 SUN Lin1 WANG Xiaobin2▲ LI Xiaodong3▲

1.Department of Gynecology and Obstetrics， Dalian Maternal and Child Health Hospital of Dalian City， Liaoning Province， Dalian 116033， China； 2.Department of Gynecology and Obstetrics， Liaoning Provincial Tumor Hospital， Liaoning Province， Shenyang 110042， China； 3.Institute of Cancer Stem Cell， Cancer Center， Dalian Medical University， Liaoning Province， Dalian 116044， China

[Abstract] Objective To explore the expression of LeY and FUT4 in patients with endometriosis and its clinical value. Methods 70 patients with endometriosis confirmed by laparoscopic surgery from March 2010 to June 2012 in Department of Gynecology and Obstetrics， Maternal and Child Health Hospital of Dalian City（“our hospital” for short）， and these patients were divided into eutopic endometrial group and ectopic endometrial group， with 35 patients in each group. 35 patients with uterine fibroids alone in our hospital during the same period were also selected as the control group. Immunohistochemistry and RT-PCR were used to detect the expression of FUT4 and LeY in endometrial tissues of three groups， the significance of their changes were evaluated and analyzed. Results ①Compared with the control group， the positive expression rate of FUT4 in eutopic endometrial group and ectopic endometrium group were significantly improved， and the difference was statistically significant （P < 0.05）， and the positive expression rate of FUT4 in ectopic endometrial group was higher than that in the eutopic endometrial group， the difference was statistically significant （P < 0.05）. ②Compared with the control group， positive expression rate of LeY in the eutopic endom etrial group and ectopic endometrium group were significantly improved， and the difference was statistically significant （P < 0.05）， positive expression rate of LeY in the ectopic endometrial group was higher than that in the eutopic endometrial group， the difference was statistically significant （P < 0.05）. ③Compared with the control group， positive expression rate of FUT4 in the ectopic endometrial group and eutopic endometrial group was significantly higher， and the difference was statistically significant （P < 0.05）， while the positive expression rate of FUT4 in the ectopic endometrial group was higher than that in the eutopic endometrial group， the difference was statistically significant （P < 0.05）. Conclusion FUT4 and LeY not only plays an important role in the formation and development of endometriosis but also in embryonic adhesion and implantation process， especially FUT4 is a key enzyme in the synthesis of LeY， while if a certain threshold is reached with its high expression， it will induce endometriosis， affecting the normal implantation of the embryo， which further leads to infertility.

[Key words] Endometriosis； Endometrium； FUT4； LeY

子宫内膜异位症是具有生长功能的子宫内膜腺体或间质异位在子宫腔外，如在生殖器、腹膜、膀胱和直肠形成浸润性病灶，个别发生在腹腔外。近年来，其发病率呈逐年上升趋势，严重影响妇女生活质量。子宫内膜异位症虽是一种良性疾病，却具有类似恶性肿瘤的黏附、侵袭等特点，并且该病具有复发性，具体的分子机制目前还不清楚。而近年来对岩藻糖基化寡糖路易斯寡糖-Y（Lewis Y，LeY）及岩藻糖基转移酶Ⅳ（fucosyltransferases 4，FUT4）是催化岩藻糖化寡糖LeY合成的关键酶的研究成为热点之一，有文献报道lewis寡糖在胚胎发育、炎症及肿瘤的转移过程中也发挥着重要作用[1]。子宫内膜异位症是一种与不孕密切相关的妇科疾病，但至今，对子宫内膜异位症不孕的发病机制尚不清楚[2]。近年大量的研究表明，异位子宫内膜细胞与在位子宫内膜细胞有重要的生化差异，如子宫内膜细胞中整合素、芳香化酶、一氧化氮合酶等表达的差异，在子宫内膜异位症导致不孕的发生中起着重要作用[3-5]。……