Rein M S, Barbieri R L, Friedman A J
Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
Am J Obstet Gynecol. 1995 Jan;172(1 Pt 1):14-8. doi: 10.1016/0002-9378(95)90077-2.
Uterine leiomyomas are monoclonal tumors. However, the factors involved in their initiation and growth remain poorly understood. The neoplastic transformation of myometrium to leiomyoma likely involves somatic mutations of normal myometrium and the complex interactions of sex steroids and local growth factors. Traditionally, estrogen has been considered the major promoter of myoma growth. The purpose of this review is to highlight the biochemical, histologic, and clinical evidence that supports an equally important role for progesterone in the growth of uterine myomas. Biochemical studies suggest that progesterone, progestins, and the progesterone receptor modulate myoma mitotic activity. Several clinical trials demonstrate that progestins inhibit and/or reverse the ability of hypoestrogenism induced by a gonadotropin-releasing hormone agonist to shrink uterine myomas, suggesting a critical role for progesterone in growth of myomas. A new hypothesis to explain the pathogenesis of myomas is presented.
子宫平滑肌瘤是单克隆肿瘤。然而，其发生和生长所涉及的因素仍知之甚少。子宫肌层向平滑肌瘤的肿瘤转化可能涉及正常子宫肌层的体细胞突变以及性类固醇和局部生长因子的复杂相互作用。传统上，雌激素一直被认为是肌瘤生长的主要促进因素。本综述的目的是强调支持孕酮在子宫肌瘤生长中同样重要作用的生化、组织学和临床证据。生化研究表明，孕酮、孕激素和孕酮受体调节肌瘤的有丝分裂活性。几项临床试验表明，孕激素抑制和/或逆转促性腺激素释放激素激动剂诱导的低雌激素状态使子宫肌瘤缩小的能力，提示孕酮在肌瘤生长中起关键作用。本文提出了一个解释肌瘤发病机制的新假说。
