Byrjalsen I, Thormann L, Meinecke B, Riis B J, Christiansen C
Department of Clinical Chemistry, Glostrup Hospital, Denmark.
Obstet Gynecol. 1992 Apr;79(4):523-8.
Healthy postmenopausal women were randomly assigned to groups receiving 28-day treatment cycles of estradiol (E2) valerate (2 mg, days 1-21) combined with medroxyprogesterone acetate (10 mg, days 12-21) (N = 18), 17 beta-estradiol (1.5 mg, days 1-24) combined with desogestrel (150 micrograms, days 13-24) (N = 20), or placebo (N = 18). The progestational effects on the endometrium were assessed by histology, uterine bleeding pattern, and biochemical markers of secretion measured in endometrial tissue (E2 and isocitrate dehydrogenase) and serum (placental protein 14). After 2 years of therapy, 24 women in the hormone groups had secretory endometrium and 13 had atrophic endometrium; in the placebo group, the results were one and 15, respectively. Withdrawal bleeding generally started between days 9-12 after the addition of progestogen in the E2-medroxyprogesterone acetate group, and between days 14-17 in the E2-desogestrel group. All three biochemical markers of secretion were increased in each of the hormone-treated groups compared with the placebo group (P less than .01-.001). Serum placental protein 14 was twice as high in the secretory as in the atrophic phase (P less than .01). Isocitrate dehydrogenase, but not E2 dehydrogenase, was also higher in the secretory phase (P less than .05). Only serum placental protein 14 was significantly related to the uterine bleeding pattern (P less than .01). We conclude that serum placental protein 14 reflects both endometrial histology and bleeding pattern and may be a useful marker of progestational effects on the endometrium. The markers of secretion measured in endometrial tissue are not as reliable for endometrial histology or bleeding pattern.
健康的绝经后女性被随机分为几组，分别接受为期28天的治疗周期，其中一组接受戊酸雌二醇（2毫克，第1 - 21天）联合醋酸甲羟孕酮（10毫克，第12 - 21天）治疗（N = 18），一组接受17β - 雌二醇（1.5毫克，第1 - 24天）联合去氧孕烯（150微克，第13 - 24天）治疗（N = 20），另一组接受安慰剂治疗（N = 18）。通过组织学、子宫出血模式以及在子宫内膜组织（雌二醇和异柠檬酸脱氢酶）和血清（胎盘蛋白14）中测量的分泌生化标志物来评估孕激素对子宫内膜的影响。治疗2年后，激素组中有24名女性的子宫内膜呈分泌期改变，13名呈萎缩期改变；在安慰剂组中，相应结果分别为1名和15名。在戊酸雌二醇 - 醋酸甲羟孕酮组中，加用孕激素后撤退性出血一般在第9 - 12天开始，在17β - 雌二醇 - 去氧孕烯组中则在第14 - 17天开始。与安慰剂组相比，各激素治疗组的所有三种分泌生化标志物均升高（P < 0.01 - 0.001）。分泌期血清胎盘蛋白14的水平是萎缩期的两倍（P < 0.01）。分泌期异柠檬酸脱氢酶升高，但雌二醇脱氢酶未升高（P < 0.05）。只有血清胎盘蛋白14与子宫出血模式显著相关（P < 0.01）。我们得出结论，血清胎盘蛋白14既反映子宫内膜组织学又反映出血模式，可能是孕激素对子宫内膜影响的有用标志物。在子宫内膜组织中测量的分泌标志物对于子宫内膜组织学或出血模式而言不太可靠。
