Santoro N, Goldsmith L T, Heller D, Illsley N, McGovern P, Molina C, Peters S, Skurnick J H, Forst C, Weiss G
Department of Obstetrics, Gynecology, and Women's Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark 07103-2757, USA.
J Clin Endocrinol Metab. 2000 Nov;85(11):4207-11. doi: 10.1210/jcem.85.11.6974.
To examine the relationship between endometrial histological maturation and reproductive hormones, we studied 11 fertile women, aged 18-37 yr. All participants had had at least 1 previous pregnancy and cycled regularly, every 25-35 days. Women collected daily, first morning voided urine for measurement of estradiol and progesterone metabolite excretion, estrone conjugates (E1c), and pregnanediol glucuronide (Pdg), respectively, throughout the cycle of study. Hormones were normalized for creatinine. Between 7-9 days after home detection of a LH surge (Sure Step), participants underwent an endometrial biopsy using a small bore (Pipelle) catheter. Tissue was prepared for histological and biochemical analyses. The histological analysis is reported herein. Endometrium was dated by 3 authors (N.S., D.H., and S.P.), all of whom were blinded to the participant's identity or timing of biopsy within her cycle. Final dating was agreed upon based upon the method of Noyes et al. E1c and Pdg were integrated throughout the cycle using the trapezoidal rule, and correlations were sought between deviation from expected histology (based upon urinary hormones and LH surge) and integrated hormone values. E1c varied over a 2-fold range in these normal women, from 1196-2040 ng/cycle. Pdg excretion was much more variable, ranging from 22-119 microg/cycle. No relationship could be found between histological lagging of endometrial maturation and lower excretion of E1c. A moderate correlation was observed (Spearman's r = 0.6; P < 0.05) between degree of histological maturation and integrated Pdg. Of two women with evidence of a disparity between gland and stromal development (glands lagging behind stroma by >2 days), one excreted 24 microg Pdg/cycle, the next to lowest value. We conclude that normal fertile women experience a wide range of hormone concentrations in the face of normal endometrial maturation. Progesterone appears to exert a dose-related effect on endometrial maturation, and the techniques we used, although relatively crude clinical measures, appeared to be sufficient to detect this relationship.
为研究子宫内膜组织学成熟与生殖激素之间的关系，我们对11名年龄在18至37岁的育龄妇女进行了研究。所有参与者既往至少有过1次妊娠，月经周期规律，每25至35天1次。在整个研究周期中，女性每天收集晨尿，分别用于测定雌二醇和孕酮代谢产物排泄、雌酮结合物（E1c）和孕二醇葡萄糖醛酸苷（Pdg）。激素水平以肌酐进行标准化。在家中检测到促黄体生成素（LH）峰（Sure Step）后7至9天，参与者使用细孔（Pipelle）导管进行子宫内膜活检。组织标本用于组织学和生化分析。本文报告组织学分析结果。子宫内膜由3位作者（N.S.、D.H.和S.P.）进行分期，他们均对参与者的身份或其月经周期内活检时间不知情。最终分期根据诺伊斯等人的方法确定。使用梯形法则对整个周期的E1c和Pdg进行积分，并寻找与预期组织学（基于尿激素和LH峰）的偏差与积分激素值之间的相关性。在这些正常女性中，E1c在2倍范围内变化，从1196至2040 ng/周期。Pdg排泄的变化更大，范围为22至119 μg/周期。未发现子宫内膜成熟的组织学滞后与E1c排泄降低之间存在相关性。在组织学成熟程度与积分Pdg之间观察到中度相关性（斯皮尔曼r = 0.6；P < 0.05）。在两名有腺体与间质发育差异证据（腺体比间质滞后>2天）的女性中，其中一名排泄的Pdg为24 μg/周期，是第二低的值。我们得出结论，面对正常的子宫内膜成熟，正常育龄女性的激素浓度范围较广。孕酮似乎对子宫内膜成熟发挥剂量相关作用，并且我们使用的技术，尽管是相对粗略的临床测量方法，但似乎足以检测到这种关系。
