探讨CXCL12/CXCR4/CXCR7 mRNA及其蛋白在子宫腺肌病(AM)患者子宫内膜与肌层组织的表达及其临床意义。

选择2016年1月至2017年12月，于台州市第一人民医院妇产科接受子宫全切及次全切术或病灶切除术，并经术后组织病理学检查确诊为AM的30例患者为研究对象，纳入研究组(n＝30)。选择同期于同一家医院接受子宫全切及次全切术，并经术后组织病理学检查确诊为子宫肌瘤的30例患者作为对照，纳入对照组(n＝30)。研究组患者术中留取在位子宫内膜及含异位病灶子宫肌层组织，对照组患者术中留取在位子宫内膜及子宫正常肌层组织，采用实时荧光定量PCR和Western blotting，分别检测子宫内膜及肌层组织中CXCL12/CXCR4/CXCR7 mRNA及其蛋白表达水平。采用成组t检验，对2组患者CXCL12/CXCR4/CXCR7 mRNA及其蛋白相对表达水平进行比较。本研究遵循的程序符合病例收集医院人体试验委员会所制定的伦理学标准，得到该委员会批准(审批文号：2015-KY004-08)，并与受试者签署临床研究知情同意书。2组患者年龄等一般临床资料比较，差异无统计学意义(P>0.05)。

①研究组患者在位子宫内膜及子宫肌层组织CXCL12 mRNA表达水平，分别为(0.05±0.01)与(0.24±0.03)，均显著高于对照组的(0.02±0.01)与(0.11±0.02)，并且差异均有统计学意义(t＝2.707、P＝0.014，t＝3.196、P＝0.009)。研究组患者在位子宫内膜组织CXCR7 mRNA表达水平为(0.007±0.002)，显著高于对照组的(0.002±0.000)，并且差异有统计学意义(t＝2.226、P＝0.035)；而在2组患者子宫肌层组织的表达水平比较，则差异无统计学意义(P>0.05)。2组患者在位子宫内膜及子宫肌层组织CXCR4 mRNA表达水平分别比较，差异均无统计学意义(P>0.05)。②2组患者在位子宫内膜及子宫肌层组织CXCL12蛋白表达水平分别比较，差异均无统计学意义(P>0.05)。研究组患者在位子宫内膜组织CXCR7蛋白表达水平为(0.88±0.19)，显著高于对照组的(0.72±0.17)，而在子宫肌层组织的表达水平为(0.69±0.21)，显著低于对照组的(1.09±0.29)，2组分别比较，差异均有统计学意义(t＝2.016、P＝0.046，t＝－2.807、P＝0.019)。研究组患者在位子宫内膜组织的CXCR4蛋白表达水平为(2.08±0.27)，显著低于对照组的(2.99±0.87)，并且差异有统计学意义(t＝－2.228、P＝0.036)，而2组患者子宫肌层的表达水平比较，差异无统计学意义(P>0.05)。

CXCL12/CXCR4/CXCR7在AM的发生、发展中发挥作用，其机制可能与CXCR7有关。CXCL12在AM发病中存在转录后调节。

To explore the expression and clinical significance of CXCL12/CXCR4/CXCR7 mRNA and its protein in endometrium and myometrium of patients with adenomyosis (AM).

From January 2016 to December 2017, a total of 30 patients who underwent total or subtotal hysterectomy or lesion resection and were diagnosed as AM by histopathological examination in Department of Obstetrics and Gynecology, Taizhou First People′s Hospital were selected as research subjects and were enrolled into study group (n=30). Another 30 patients who underwent total or subtotal hysterectomy and were diagnosed as uterine fibroids by histopathological examination in the same hospital during the same period were selected as control and enrolled into control group (n=30). In study group, eutopic endometrium tissues and myometrium tissues with ectopic lesions were retained during operation. In control group, the eutopic endometrium and normal myometrium tissues were retained during operation. CXCL12/CXCR4/CXCR7 mRNA and its protein expression levels in tissues of two groups were evaluated by real-time fluorescence quantitative PCR and Western blotting methods, and were compared by independent-samples t test. This study was approved by the Ethics Committee of Taizhou First People′s Hospital (Approval No. 2015-KY004-08). Informed consents were obtained from all subjects. There were no statistically significant differences in general clinical data between two groups, such as age and so on (P>0.05).

①The expression levels of CXCL12 mRNA in eutopic endometrium tissue and myometrium tissue with ectopic foci of study group were (0.05±0.01) and (0.24±0.03) respectively, which were both significantly higher than those of control group (0.02±0.01) and (0.11±0.02), and both the differences were statistically significant (t=2.707, P=0.014; t=3.196, P=0.009). Expression level of CXCR7 mRNA in eutopic endometrium tissue of study group was (0.007±0.002), which was significantly higher than that of control group (0.002±0.000), and the difference was statistically significant (t=2.226, P=0.035), while there was no statistical difference between two groups in expression level of CXCR4 mRNA in myometrium tissue (P>0.05). ②There were no statistical differences between two groups in expression levels of CXCL12 protein both in eutopic endometrium and myometrium tissues (P>0.05). Expression level of CXCR7 protein in eutopic endometrium tissue of study group was (0.88±0.19), which was significantly higher than that of control group (0.72±0.17), while expression level in myometrium tissue was (0.69±0.21), which was significantly lower than that of control group (1.09±0.29), and both the differences were statistically significant (t=2.016, P=0.046; t=-2.807, P=0.019). Expression level of CXCR4 protein in eutopic endometrium tissue of study group was (2.08±0.27), which was significantly lower than that of control group (2.99±0.87), and the difference was statistically significant (t=-2.228, P=0.036), while expression level of CXCR4 protein in myometrium tissue of two groups were not statistically significant (P>0.05).

CXCL12/CXCR4/CXCR7 plays a role in the occurrence and development of AM, and its mechanism may be related to CXCR7. The expression of CXCL12 in AM shows regulation at transcriptional level.