Sa Ri-Na, Song Jing-Hui
Department of Obstetrics and Gynecology, Affiliated Hospital, Inner Mongolia Medical College, Hohhot 010050, China.
Zhonghua Fu Chan Ke Za Zhi. 2010 Oct;45(10):762-6.
to investigate the relationship between the ultrastructural features combined with the expression of connexin (Cx43) protein in uterine junction zone and pathogenesis of adenomyosis.
from Nov. 2008 to Nov. 2009, 30 patients with adenomyosis (including 14 cases with proliferative endometrium and 16 cases with secretory endometrium) as study group matched with 30 women with cervical intraepithelial neoplasia (CIN) III treated by hysterectomy as control group were enrolled in this study in Affiliated Hospital to Inner Mongolia Medical College. The expression of Cx43 in uterine junction zone of patients with adenomyosis was detected by immunohistochemisty staining. The ultrastucture of eutopic endometrium, uterine junction zone and outer 1/3 myometrium in both groups without history of dilatation and curettage, C-section and uterine surgery were observed by using transmission electron microscopy.
(1) the expression of Cx43 in proliferative and secretroy uterine junction zone were 0.133 ± 0.018 and 0.137 ± 0.021 in study group and 0.154 ± 0.016 and 0.141 ± 0.018 in control group, which reached statistical difference (P < 0.05). However, it didn't show significant expression of Cx43 between proliferative and secretory uterine junction zone in study or control group (P > 0.05). The expression of Cx43 in proliferative and secretory of eutopic endometrium of 0.067 ± 0.017 and 0.062 ± 0142 in study group were significantly lower than 0.094 ± 0.005 and 0.080 ± 0.005 in control group. It didn't show statistical difference of Cx43 expression between proliferative and secretroy eutopic endometrium in both group. The expression Cx43 in outer myometrium of proliferative phase were 0.184 ± 0.022 in study group and 0.188 ± 0.028 in control group, which did not show significant difference (P > 0.05). It also did not exhibit statistical difference of Cx43 expression in outer myometrium of secretory phase (0.178 ± 0.022, 0.191 ± 0.025, P > 0.05). (2) Morphological changes: the area of uterine smooth muscle cells of the uterine junction zone of (24.3 ± 1.6) microm(2) in study group were significantly increased than (21.8 ± 2.0) microm(2) in control group (P < 0.01). The length of the cell membrane dense plaques of (1.07 ± 0.17) microm in study group was significantly increased than (0.71 ± 0.07) microm in control group (P < 0.01). The myocytes exhibited cellular hypertrophy and disordered arrangement and fewer caveolae. There was cylindrical and dentate, chromatin margination, more heterochromatin in which muscle cells of nuclear surface of the uterine junction zone. Less cytoplasmic myofilaments and more intermediate filaments. Mitochondria were increased, the volume increased significantly vacuolization. The rough endoplasmic reticulum and Golgi apparatus were more prominent. Otherewise, mast cells and fibroblasts were close and glandular epithelial cells showed desmosome connection which villus thickening and dense. All features were more prominent at the junctional zone.
the down-regulation of Cx43 expression and ultrastructure changes in the junction zone might play an important role in pathogenesis of adenomyosis.
探讨子宫肌层结合带超微结构特征及连接蛋白（Cx43）蛋白表达与子宫腺肌病发病机制的关系。
选取2008年11月至2009年11月在内蒙古医学院附属医院就诊的30例子宫腺肌病患者（其中增生期子宫内膜14例，分泌期子宫内膜16例）作为研究组，另选取30例行子宫切除术的宫颈上皮内瘤变（CIN）Ⅲ级患者作为对照组。采用免疫组织化学染色法检测子宫腺肌病患者子宫肌层结合带Cx43的表达。应用透射电子显微镜观察两组无刮宫、剖宫产及子宫手术史患者的在位内膜、子宫肌层结合带及子宫外1/3肌层的超微结构。
（1）研究组增生期和分泌期子宫肌层结合带Cx43表达分别为0.133±0.018、0.137±0.021，对照组分别为0.154±0.016、0.141±0.018，差异有统计学意义（P<0.05）。研究组和对照组增生期与分泌期子宫肌层结合带Cx43表达差异均无统计学意义（P>0.05）。研究组增生期和分泌期在位内膜Cx43表达分别为0.067±0.017、0.062±0.0142，显著低于对照组的0.094±0.005、0.080±0.005。两组增生期与分泌期在位内膜Cx43表达差异均无统计学意义。研究组增生期子宫外肌层Cx43表达为0.184±0.022，对照组为0.188±0.028，差异无统计学意义（P>0.05）。分泌期子宫外肌层Cx43表达差异也无统计学意义（0.178±0.022、0.191±0.025，P>0.05）。（2）形态学改变：研究组子宫肌层结合带子宫平滑肌细胞面积为（24.3±1.6）μm²，显著大于对照组的（21.8±2.0）μm²（P<0.0）。研究组细胞膜致密斑长度为（1.07±0.17）μm，显著长于对照组的（0.71±0.07）μm（P<0.01）。肌细胞表现为细胞肥大、排列紊乱，小凹减少。子宫肌层结合带肌细胞核表面呈圆柱状和齿状，染色质边集，异染色质增多。胞质内肌丝减少，中间丝增多。线粒体增多，体积增大，明显空泡化。粗面内质网和高尔基体更突出。此外，肥大细胞和成纤维细胞靠近，腺上皮细胞可见桥粒连接，绒毛增粗、致密。所有这些特征在结合带更明显。
子宫肌层结合带Cx43表达下调及超微结构改变可能在子宫腺肌病发病机制中起重要作用。
