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Objective1. Approaching the Hysteroscopy manifestations of the bleeding during the ovulation period, combining with the clinical manifestations and the pathoiogical results; investigating the causes to the bleeding during the ovulation period, this may provide certain assistance to the future clinical diagnosis and treatment.2. Detecting the expression levels of factors (Fas) and transforming growth factor (TGF-β1) in the endomembrane tissue found in the bleeding during the ovulation period, approach the relationship between the mechanism of the bleeding and them.Methods1. Analysing retrospectively the clinical cases, in which including 106 patients who have this condition taking the Hysteroscopy examinations in General Hospital of Jinan Military Region during January 2007 to September 2010. All of the patients have regular menstruations, and do the ultrasound and gynecologic examinations. 34cases of them are found abnormal resonance in their uterus cavity, with the rest of them are normal in both examinations. All the patients hadn’t taken any hormone drugs by mouth for at least six months when the datas were collected. The final diagnoses are made according the hysteroscope under direct vision endomembrane manifestations, along with the assistance of the pathological results of the Diagnostic curettage tissue. According to the Hysteroscopy manifestations, there are 57 cases of endometrial polyps, 29 cases of cervical polyp, 13 cases of submucosal trine fibroids, and 7cases of endometrial inflammation. Approach the causes of the bleeding during the ovulation period with the pathological results of the patients’Diagnostic curettage tissue. Analyse the dependability between the hysteroscopy diagnosis and the pathological diagnosis, and run the statistics analysis.2. Applicationing with the FCM to detective the expression levels of the Fas and TGF-β1 in the 62 cases patients, and take 45 cases with normal endomembrane as the control group. According the Hysteroscopy manifestations, they can be devided into 4 groups, which are 31 cases of endometrial polyps, 17 cases of cervical polyp, 8 cases of submucosal uterine fibroids, and 6 cases of Endometrial inflammation. According to the pathological typing of the Diagnostic curettage tissue gained during the ovulation period, they can be devided into 2 groups, which are the Proliferative group and the Secretory group. Analyse the expression levels of the cytokine Fas, TGF-β1in all these groups, and explore their meanings.Results1. The results in hysteroscopy examinations and pathological diagnosisAmong the patients who have bleeding during the ovulation period, 57 are diagnosed as endometrial polyps, taking 55.66 percentages, by Hysteroscopy examinations. And the coincidence to the pathological diagnosis is as high as 99.06%;which 2 cases no Endometrial polyps performance but have the pathological diagnosis performance, The specificity, sensibility were 100%, 96.61%;Equally, 29 cases of Cervical polyp, taking27.36 percentage,13 cases of Submucosal uterine fibroids, taking 12.26 percentage,7 cases of Endometrial inflammation, taking 6.60 percentage; the coincidences to the pathological diagnosis are 97.17%, 98.11%,96.23% respectively. The specificity, sensibility of the Hysteroscopy diagnosis in Cervical polyp are 100%,93.55%; in Submucosal uterine fibroids are 95.88%, 100%; in Endometrial inflammation are 96.12%,100%.2. The expression of Fas, TGF-β1 in uterus endomembrane tissue(1)The expression of Fas in uterus endomembrane tissue Fas expresses in the normal uterus endomembrane tissue: in the normal tissue, high level expression has been detected, and When it comes to the expression levels of Fas in normal endomembrne, in the Proliferative group is (2.27±1.21)%, in the Secretory group is (2.81±0.39)%;The two groups have no statistical significances (P>0.05).Fas expresses in the bleeding tissue during the ovulation period: in the bleeding tissue during the ovulation period, low level expression has been detected. Which of the expresses in Endometrial polyps group, Cervical polyp group, Submucosal uterine fibroids group and Endometrial inflammation group are(1.67±1.20)%, (2.06±1.01)%, (2.11±0.73)%,(2.30±1.61)%;The order of the groups according to the Fas expression level in the bleeding tissue is Endometrial polyps group < Cervical polyp group < Submucosal uterine fibroids group < Endometrial inflammation group. Among them, the differences of the Endometrial polyps group and Cervical polyp group have statistical significances by comparing to the control group (P<0.05).Meanwhile, the differences of the Endometrial polyps group and Endometrial inflammation group have no statistical significances (P>0.05).(2)The expression of TGF-β1in uterus endomembrane tissueTGF-β1 expresses in the normal uterus endomembrane tissue: in the normal uterus endomembrane tissue, low level expression has been detected, and When it comes to the expression levels of Fas in normal endomembrne, in the Proliferative group is (2.96±1.04)% in the Secretory group is (3.09±0.53)%;The two groups have no statistical significances(P>0.05). TGF-β1expresses in the bleeding tissue during the ovulation period: in the bleeding tissue during the ovulation period, high level expression has been detected. Which of the expresses in Endometrial polyps group, Cervical polyp group, Sub mucosal uterine fibroids group and Endometrial inflammation group are(3.52±0.89)%, (3.03±0.81)%,(2.86±1.42)%,(2.34±1.39)%,The order of the groups according to the Fas expression level in the bleeding tissue is Endometrial polyps group>Cervical polyp group> Submucosl uterine fibroids group > Endometrial inflammation group. Among them, the differences of the Endometrial polyps group and Cervical polyp group have statistical significances by comparing to the control group (P>0.05).Meanwhile, the differences of the Endometrial polyps group and Endometrial inflammation group have no statistical significances (P>0.05).(3)The correlation in Fas and TGF-β1In the bleeding tissue during the ovulation period, the expression levels of Fas and TGF-β1 tend to be negative correlation, which in Endometrial polyps group, Cervical polyp group and Sub mucosal uterine fibroids group, the differences have statistical significances (P<0.05). But in Endometrial inflammation group, the differences have no statistical significances (P>0.05).Conclusions1. By the Hysteroscopy examinations in the bleeding tissue during the ovulation period, we fined the bleeding during the ovulation period is not only caused by the disorder of the estrogen and lutin receptors level, Endometrial polyps, Cervical polyp, Submucosal uterine fibroids and Endometrial inflammation are the main causes lead to the bleeding tissue during the ovulation period, among them, the Endometrial polyps group has a high morbidity. This may remind us that the endometrial polyps group might be the main reason which could cause the bleeding tissue during the ovulation period, at the same time; Hysteroscopy examination has high specificity and sensibility in the diagnosis. It also has a high coincidence to the pathological results, which can make up the shortages of the B-type ultrasound and the gynecologic examinations, and becomes the main method to diagnose the bleeding during the ovulation period gradually. Matching with the site-specific Diagnostic curettage, it becomes the“Golden Standard”of the diagnosis.2. Fas expresses in the normal uterus endomembrane tissue is high level, and the Secretory group is higher than the Proliferative group; in the bleeding tissue during the ovulation period, low level expression has been detected. In particular, the low expression of the weak in Endometrial polyps and Cervical polyp, This remind us that Fas can made imbalance in proliferation cells and apoptotic cells, lead to the different propagation in local endomembrane tissue, procreate the polyp, ultimately result in the bleeding tissue during the ovulation period.3. TGF-β1 expresses in the normal uterus endomembrane tissue is low level, in the bleeding endomembrane during the ovulation period is high. so this might mean that, may be it can accommodate the formation of vein in the bleeding endomembrane during the ovulation period, and made the blood vessel formation in the high active state, the endomembrane have a obvious congestion and when the congestion reach to a certain extent, the blood vessel diabrosis, that may be to appear a little bit of hemorrhage. That is the bleeding endomembrane during the ovulation period. TGF-β1 expresses in endometrial polyps is higher, this remind us TGF-β1may be direct or indirect to participate in uterus endomembrane tissue, induce hyperplasia in endomembrane tissue, thereby to lead to nascency and evolution in the endometrial polyps, finally begot the bleeding endomembrane during the ovulation period.4. In the bleeding tissue during the ovulation period, the expression levels of Fas and TGF-β1 tend to be negative correlation. It indicates that the mechanism of the bleeding during the ovulation period is complicated. They have close dependability, and together to promote the occurrence of the bleeding during the ovulation period.
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