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目的：研究促性腺激素释放激素激动剂(GnRH-alpha)对子宫内膜异位症（EMs）患者在位内膜蛋白表达的影响，为EMs 的治疗提供依据。方法：94 例EMs 患者随机分为两组，每组47 例，均实施腹腔镜手术治疗，对照组未给予药物治疗，观察组给予曲普瑞林皮下注射，28 日/ 次，注射3 次，术中及治疗三个月后观察组分别用取内膜器取少量子宫内膜组织标本，采用免疫组化法法、 TUNEL染色法和Western blot检测组织内Bcl-2、Caspase3、GRP78 等表达情况，并观察治疗效果。结果：治疗后观察组疼痛视觉模拟评分（VAS）为(2.13± 0.69)分，低于对照组的(2.62± 0.71)分（P<0.05)；观察组1 年内妊娠率及总妊娠率分别为38.30%、51.06%，均高于对照组的19.15%、29.79%（P<0.05)；治疗后观察组Bcl-2、Caspase3 表达量分别为(1.54± 0.28)、(3.20± 0.65)，均高于对照组的(1.38± 0.15)、(1.24± 0.27)（P<0.05)；治疗后观察组GRP78 表达量为(0.46± 0.17)，低于对照组的(0.61± 0.24)（P<0.05）。结论： GnRH-alpha可缓解EMs患者下腹痛、痛经、性交痛等症状，提高妊娠率，其机制可能与GnRH琢调控上皮细胞Bcl-2、Caspase3、GRP78 等的表达有关。

英文摘要:

Objective:To investigate the impacts of Gonadotropin-releasing hormone agonists (GnRH-alpha) on the eutopic endometriumprotein expression in patients with Endometriosis (Ems), so as to provide the basis for the treatment of EMs.Methods:All of the 94 patients with EMs were randomly divided into two groups, 47 cases in each group. All of themunderwent laparoscopic surgery. Then patients in the control group did not receive drug treatment, while those in observation group received pregabalin injection, 28 d/time, 3 times in total. The endometrial tissue specimens of diameter 2 ~ 3 cm were resected during the operation and at three months after operation. Then the Bcl-2, Caspase3 and GRP78 expressions in tissues were detected by immunohistochemistry method, TUNEL staining and Western blot detection. The treatment effects were also observed.Results:After treatment, the pain visual analogue scale (VAS) score in the observation group was (2.13± 0.69) points, lower than that in the control group which was (2.62± 0.71) points (P<0. 05). The one year pregnancy rate and overall pregnancy rate was 38.30% and 51.06% respectively in the observation group. Both were higher than the 19.15%, 29.79% of the control group (P<0.05). After treatment, the Bcl-2 and Caspase3 expression were respectively (1.54± 0.28) and (3.20± 0.65) in observation group, respectively higher than the (1.38± 0.15) and (1.24± 0.27) in the control group (P<0.05). However, the GRP78 expression was (0.46± 0.17), lower than (0.61± 0.24) in control group (P<0.05).Conclusion:GnRH琢 can alleviate the symptoms of patients with EMs, improve the pregnancy rate. The mechanism may be related with that GnRH-alpha regulates the Bcl-2, Caspase3, GRP78 and other relevant expressions in epithelial cells.

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