Lessey B A, Castelbaum A J, Wolf L, Greene W, Paulson M, Meyer W R, Fritz M A
University of North Carolina, Chapel Hill, North Carolina, USA.
Fertil Steril. 2000 Apr;73(4):779-87. doi: 10.1016/s0015-0282(99)00604-4.
To compare traditional histologic dating criteria of the endometrium with immunohistochemical criteria based on epithelial integrin expression during the menstrual cycle.
Prospective clinical study.
An academic teaching hospital.
PATIENT(S): Fertile and infertile women undergoing endometrial biopsy.
MAIN OUTCOME MEASURE(S): Immunohistochemical staining intensity and distribution (HSCORE) of three integrins and traditional histologic endometrial dating.
RESULT(S): In 1,501 endometrial specimens, phase assignment-based integrin staining was 95% and 85% concordant with histology for the proliferative and early secretory phase, respectively, but only 54% and 49% concordant for the middle and late secretory phase, respectively. The greatest disagreement occurred during the midluteal phase. Of 1,090 patients who underwent sampling 6-10 days after detection of a urinary LH surge (corresponding to cycle days 20-24), multiple logistic regression analysis revealed that endometriosis was positively correlated and male factor infertility was negatively correlated with absent beta3 integrin subunit expression. Diagnosis and absent epithelial alpha4beta1 expression were not related. Patient age was not correlated with the incidence of abnormalities in integrin expression.
CONCLUSION(S): Traditional histologic dating of the endometrium has remained the gold standard for nearly 50 years. Although the use of marker proteins provides additional information and may reflect endometrial function or receptivity, such markers cannot yet replace traditional methods of endometrial assessment.
比较月经周期中基于上皮整合素表达的免疫组化标准与传统子宫内膜组织学分期标准。
前瞻性临床研究。
一所学术教学医院。
接受子宫内膜活检的有生育能力和无生育能力的女性。
三种整合素的免疫组化染色强度和分布（HSCORE）以及传统的子宫内膜组织学分期。
在1501份子宫内膜标本中，基于分期的整合素染色在增殖期和早分泌期与组织学的一致性分别为95%和85%，但在中分泌期和晚分泌期分别仅为54%和49%。最大的差异出现在黄体中期。在1090例在检测到尿促黄体生成素峰后6 - 10天（对应于月经周期第20 - 24天）进行取样的患者中，多因素logistic回归分析显示，子宫内膜异位症与β3整合素亚基表达缺失呈正相关，男性因素不孕与β3整合素亚基表达缺失呈负相关。诊断与上皮α4β1表达缺失无关。患者年龄与整合素表达异常的发生率无关。
近50年来，传统的子宫内膜组织学分期一直是金标准。尽管使用标记蛋白可提供额外信息并可能反映子宫内膜功能或容受性，但此类标记物尚不能取代传统的子宫内膜评估方法。
