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子宫内膜息肉(EPs)是一种局部子宫内膜腺体和间质过度生长的子宫内膜良性病变，主要表现为异常子宫出血、不孕等，且EPs切除术后易复发，影响女性的生殖健康，因此明确EPs发病机制尤为重要。本文从遗传学因素、细胞增殖与凋亡失衡、激素失衡、炎性因子分泌异常以及免疫细胞比例失衡方面综述了EPs的发病机制，以期为更深入的机制研究提供更多参考。
Abstract：Endometrial polyps(EPs) are benign endometrial lesions involving excessive growth of local endometrial glands and stroma, manifested mainly as abnormal uterine bleeding and infertility. EPs are prone to recurrence after resection, affecting women's reproductive health. For this reason, elucidating the pathogenesis of EPs is of particular importance. This article reviews the pathogenesis of EPs from the perspectives of genetic factors, imbalance between cell proliferation and apoptosis, hormonal imbalance, abnormal secretion of inflammatory factors, and imbalance in the proportion of immune cells, in order to provide a reference for more insights of mechanism research.
[1] 中国优生科学协会生殖道疾病诊治分会，中国医师协会微无创医学专业委员会妇科肿瘤学组.子宫内膜息肉诊治中国专家共识(2022年版)[J].中国实用妇科与产科杂志，2022,38:809-813.
[2] Sahoo SS,Aguilar M,Xu Y,et al.Endometrial polyps are non-neoplastic but harbor epithelial mutations in endometrial cancer drivers at low allelic frequencies[J].Mod Pathol,2022,35:1702-1712.
[3] Takeda T,Banno K,Kobayashi Y,et al.Mutations of RAS genes in endometrial polyps[J].Oncol Rep,2019,42:2303-2308.
[4] Tokmak A,Ozaksit G,Sarikaya E,et al.Decreased ADAMTS-1,-9 and -20 levels in women with endometrial polyps:a possible link between extracellular matrix proteases and endometrial pathologies[J].J Obstet Gynaecol,2019,39:845-850.
[5] Koduru P,Sahoo SS,Aguilar M,et al.Endometrial polyps-are they characterized by HMGA rearrangements or not?Reply to Bullerdiek et al[J].Mod Pathol,2023,36:100058.
[6] Atak Z,Turhan EI,Rahimli Ocakoglu S,et al.Symptom-related Ki-67 expression in endometrial polyps[J].Eur J Obstet Gynecol Reprod Biol,2022,272:139-143.
[7] Giordano MV,Lucas H,Fiorelli R,et al.Expression levels of BCL2 and MKI67 in endometrial polyps in postmenopausal women and their correlation with obesity[J].Mol Clin Oncol,2020,13:69.
[8] Banas T,Pitynski K,Mikos M,et al.Endometrial polyps and benign endometrial hyperplasia have increased prevalence of DNA fragmentation factors 40 and 45(dff40 and dff45) together with the antiapoptotic b-cell lymphoma(bcl-2) protein compared with normal human endometria[J].Int J Gynecol Pathol,2018,37:431-440.
[9] Gokmen Karasu AF,Sonmez FC,Aydin S,et al.Survivin expression in simple endometrial polyps and tamoxifen-associated endometrial polyps[J].Int J Gynecol Pathol,2018,37:27-31.
[10] Middelkoop MA,Don EE,Hehenkamp W,et al.Angiogenesis in abnormal uterine bleeding:a narrative review[J].Hum Reprod Update,2023,29:457-485.
[11] McGurgan P,Taylor LJ,Duffy SR,et al.Are endometrial polyps from pre-menopausal women similar to post-menopausal women?An immunohistochemical comparison of endometrial polyps from pre- and post-menopausal women[J].Maturitas,2006,54:277-284.
[12] Inceboz US,Nese N,Uyar Y,et al.Hormone receptor expressions and proliferation markers in postmenopausal endometrial polyps[J].Gynecol Obstet Invest,2006,61:24-28.
[13] Nogueira AA,Sant’Ana de Almeida EC,Poli Neto OB,et al.Immunohistochemical expression of p63 in endometrial polyps:evidence that a basal cell immunophenotype is maintained[J].Menopause,2006,13:826-830.
[14] Cobellis L,Caprio F,Trabucco E,et al.The pattern of expression of Notch protein members in normal and pathological endometrium[J].J Anat,2008,213:464-472.
[15] 田文艳，张慧英，薛凤霞.子宫内膜息肉诊治中国专家共识(2022年版)解读[J].实用妇产科杂志，2023,39:29-33.
[16] Rshoud FA,Omari BA,Qudsi A,et al.Polycystic ovarian syndrome - association and risk factors between endometrial polyp and infertility.A retrospective study[J].Prz Menopauzalny,2022,21:106-110.
[17] Detti L,Peregrin-Alvarez I,Saed GM.Association between redundant endometrium and endometrial polyps:a pilot study[J].Minerva Obstet Gynecol,2023,75:219-226.
[18] Peng X,Li T,Xia E,et al.A comparison of oestrogen receptor and progesterone receptor expression in endometrial polyps and endometrium of premenopausal women[J].J Obstet Gynaecol,2009,29:340-346.
[19] Dibi RP,Zettler CG,Vanin C,et al.Immunohistochemical assessment of symptomatic postmenopausal endometrial polyps in tamoxifen users and nonusers:a case control study[J].Sao Paulo Med J,2020,138:64-68.
[20] Vitale SG,Haimovich S,Laganà AS,et al.Endometrial polyps an evidence-based diagnosis and management guide[J].Eur J Obstet Gynecol Reprod Biol,2021,260:70-77.
[21] Cohen I,Azaria R,Shapira J,et al.Significance of secondary ultrasonographic endometrial thickening in postmenopausal tamoxifen-treated women[J].Cancer,2002,94:3101-3106.
[22] Polin SA,Ascher SM.The effect of tamoxifen on the genital tract[J].Cancer Imaging,2008,8:135-145.
[23] Gerber B,Krause A,Müller H,et al.Effects of adjuvant tamoxifen on the endometrium in postmenopausal women with breast cancer:a prospective long-term study using transvaginal ultrasound[J].J Clin Oncol,2000,18:3464-3470.
[24] McGurgan P,Taylor LJ,Duffy SR,et al.Does tamoxifen therapy affect the hormone receptor expression and cell proliferation indices of endometrial polyps?an immunohistochemical comparison of endometrial polyps from postmenopausal women exposed and not exposed to tamoxifen[J].Maturitas,2006,54:252-259.
[25] Le?o RB,Andrade L,Vassalo J,et al.Differences in estrogen and progesterone receptor expression in endometrial polyps and atrophic endometrium of postmenopausal women with and without exposure to tamoxifen[J].Mol Clin Oncol,2013,1:1055-1060.
[26] Sarioglu E,Vural F,Ertürk Co?kun AD.The relationship of endometrial pathologies with endometrial thickness and inflammatory markers in breast cancers using tamoxifen[J].Arch Gynecol Obstet,2023,307:565-571.
[27] Karena ZV,Shah H,Vaghela H,et al.Clinical utility of mifepristone:apprising the expanding horizons[J].Cureus,2022,14:e28318.
[28] Peng J,Guo J,Zeng Z,et al.Endometrial polyp is associated with a higher prevalence of chronic endometritis in infertile women[J].Int J Gynaecol Obstet,2022:159:563-567.
[29] Liang J,Li M,Zhang L,et al.Analysis of the microbiota composition in the genital tract of infertile patients with chronic endometritis or endometrial polyps[J].Front Cell Infect Microbiol,2023,13:1125640.
[30] Bozkurt M,?ahin L,Ula? M.Hysteroscopic polypectomy decreases NF-κB1 expression in the mid-secretory endometrium of women with endometrial polyp[J].Eur J Obstet Gynecol Reprod Biol,2015,189:96-100.
[31] Wang X,Chen J,Zheng J.The roles of COX-2 in protozoan infection[J].Front Immunol,2023,14:955616.
[32] Tsyndrenko N,Lyndin M,Sikora K,et al.ER and COX2 expression in endometrial hyperplasia processes[J].Medicine(Baltimore),2023,102:e34864.
[33] Pinheiro A,Antunes J,Andrade L,et al.Expression of hormone receptors,Bcl-2,Cox-2 and Ki67 in benign endometrial polyps and their association with obesity[J].Mol Med Rep,2014,9:2335-2341.
[34] Gao J,Tian J,Lv Y,et al.Leptin induces functional activation of cyclooxygenase-2 through JAK2/STAT3,MAPK/ERK,and PI3K/AKT pathways in human endometrial cancer cells[J].Cancer Sci,2009,100:389-395.
[35] 杜国平，张炜，王丽，等.凝集素半乳糖结合蛋白3在人子宫内膜的表达[J].复旦学报(医学版),2006,33:143-146.
[36] Gounaris E,Erdman SE,Restaino C,et al.Mast cells are an essential hematopoietic component for polyp development[J].Proc Natl Acad Sci USA,2007,104:19977-19982.
[37] Al-Jefout M,Black K,Schulke L,et al.Novel finding of high density of activated mast cells in endometrial polyps[J].Fertil Steril,2009,92:1104-1106.
[38] Zhu Y,Du M,Yi L,et al.CD4+ T cell imbalance is associated with recurrent endometrial polyps[J].Clin Exp Pharmacol Physiol,2018,45:507-513.
[39] Li XH,Lu MY,Niu JL,et al.cfDNA methylation profiles and T-cell differentiation in women with endometrial polyps[J].Cells,2022,11:3989.
基本信息:
中图分类号:R711.74
引用信息:
[1]蒯丹,唐清涛,李小燕,等.子宫内膜息肉发病机制研究进展[J].生殖医学杂志,2024,33(08):1109-1113.
基金信息:
国家自然科学基金(82171629); 天津市医学重点学科(专科)建设项目资助(TJYXZDXK-031A); 天津市自然科学基金(23JCYBJC00720)
2023-11-27
2023
2024-07-05
2024
2024-01-10
1
2024-08-15
2024-08-15