자궁근종 내 프로게스테론 수용체와 혈관상태가 근종의 성장과 임상증상에 미치는 영향
Influence of progestrone receptor and vascularity in leiomyoma to the growth and clinical symptoms
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목적: 자궁근종은 여성에서 발생하는 골반종양 가운데 가장 발생률이 높은 양성 종양으로, 여성 호르몬의 영향을 받는 대표적인 종양이다. 당장 치료를 요하지 않는 근종은 추적검사를 시행하는데, 향 후 근종의 임상경과를 예측할 수 있는 뚜렷한 방법이 없었다. 저자들은, 자궁근종의 호르몬 수용체와 혈관 상태를 평가하여 자궁근종의 향 후 임상경과를 예측 할 수 있는지 알아보고자 한다. 연구 방법: 단독 자궁근종이 있는 폐경 전 여성을 대상으로 병원 첫 방문 시 자궁근종 생검과 호르몬 혈액검사를 실시하였다. 자궁근종 생검에서 프로게스테론 수용체의 상태가 75% 이상 양성 (strong positive)인 군과, 프로게스테론 수용체가 25% 미만을 보이는 군 (trace and negative)으로 분류한다. 또한 도플러초음파를 통해 근종 먹이동맥의 혈관 상태- 저항지수 (Resistance index: RI)의 상태를 확인한다. 임상증상의 중등도는 생리주기, 생리양, 생리통, 골반통에 대한 설문지 (Uterine fibroid symptom and health-related quality of life questionnaire : UFS-QOL)를 사용하여 확인한다. 결과: 연구에 포함된 인원은 총 30명으로, 평균 연령은 38.2세, 산과력 1.8이었다. 8개월 추적검사 후, 초기 프로게스테론 수용체가 25% 미만인 군에 비해 75% 이상인 군은 근종의 부피가 유의하게 증가하였으며, 초기 프로게스테론 수용체 상태가 강양성으로 나오는 경우, 환자의 증상 및 삶의 질이 악화되었다. 또한 초기 프로게스테론 수용체 상태가 25% 미만인 경우 8개월 후 환자의 증상 및 삶의 질이 호전되었다. 결론: 이상의 결과에서, 초기 근종의 호르몬 수용체 상태와 먹이혈관의 도플러 추적검사 결과로 임상경과의 변화를 예측할 수 있음을 알 수 있었다.
Abstract
Objective: Myoma is the most frequent benign tumor in women’s pelvic cavity. Myoma causes a lot of symptoms that degrade the life quality of the patients. If the patient with leiomyoma does not require the treatment, regular follow-up is recommended. However, there is no definite method to predict the clinical outcome of leiomyoma patients. So we evaluate if the hormone receptors and vascular viability can predict the clinical outcomes in leiomyoma patients. Methods: We perform the leiomyoma biopsy and ultrasonogram in leiomyoma patients who are symptomatic, premenopaused, and unnecessary to receive treatment. The patients were grouped into two as the results of progesterone receptor status of leiomyoma ; strong positive (≥75% positive to progesterone receptor), trace and negative (<25% positive to progesterone receptor). Also, we evaluates the vascular state and the resistance index (RI) of feeding arteries of myoma with doppler ultrasonogram. The severities of clinical symptoms are interpreted by using Uterine fibroid symptom and health-related quality of life questionnaire (UFS-QOL). Results: After 8 months, the strong positive group shows the greater increasement of myoma volume than the trace and negative group. Also, the patient’s symptoms and scores of life-quality decrease in strong positive group. In contrast, the trace and negative group show the improvement in clinical symptoms and life-quality. Conclusion: As a result, we concluded the status of hormonal receptor and feeding arteries can predict the clinical change of leiomyoma.
참고문헌 (24)
- Buttram VC Jr, "Uterine leiomyomata: etiology, symptomatology, and management", Fertil Steril, 36, pp.433~445 (1981)
- Muran D, "Myomas of the uterus in pregnancy: ultrasonogrphic follow-up", Am J Obstet Gynecol, 138, pp.16~19 (1980)
- Rosati P, "Longitudinal evluation of uterine myoma growth during pregnancy. A sonographic study", J Ultrasound Med, 11, pp.511~515 (1992)
- Tsuda H, "Clinical predictors in the natural history of uterine leiomyoma: preliminary study", J Ultrasound Med, 17, pp.17~20 (1998)
- Aleem FA, "The hemodynamic effect of GnRH agonist therapy on uterine leiomyoma vascularity: a prospective study using transvaginal color Doppler sonography", Gynecol Endocrinol, 9, pp.253~258 (1995)
- Spies JB, "The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata", Obstet Gynecol, 99, pp.290~300 (2002)
- Lantta M, "Progesterone and estradiol receptors in the cystosol of the human uterine artery", Am J Obstet Gynecol, 147, pp.627~633 (1983)
- Soules MR, "Leiomyomas: steroid receptor content-variation within normal menstrual cycle", Am J Obstet Gynecol, 143, pp.6~11 (1982)
- de Zigler D, "Vascular resistance of uterine arteires: physioloigcal effects of estradiol and progesterone", Fertil Steril, 55, pp.775~779 (1991)
- Folberg R, "Vasculogenic mimicry and tumor angiogenesis", Am J Pathol, 156, pp.361~381 (2000)
- Ribatti D, "Angiogenesis under normal and pathological conditions", Haematologica, 76, pp.311~320 (1991)
- Huang SC, "Intratumoral blood flow in uterine myoma correlated with a lower tumor size and volume, but not correlated with cell proliferation or angiogenesis", Obstet Gynecol, 87, pp.1019~1024 (1996)
- Sosić A, "Vascularity of uterine myomas: assessment by color and pulsed Doppler ultrasound", Int J Gynaecol Obstet, 54, pp.245~250 (1996)
- Kurjak A, "The characterization of uterine tumors by transvaginal color doppler", Ultrasound Obstet Gynecol, 1, pp.50~52 (1991)
- Kurjak A, "The assessment of benign uterine tumor vascularization by transvaginal color Doppler", Ultrasound Med Bio, 18, pp.645~649 (1992)
- Englund K, "Sex steroid receptors in human myometrium and fibroids: changes during the menstrual cycle and gonadotropin- releasing hormone treatment", J Clin Endocrinol Metab, 83, pp.4092~4096 (1998)
- Nisolle M, "Immunohistochemical study of the proliferation index, oestrogen receptors and progesterone receptors A and B in leiomyomata and normal myometrium during the menstrual cycle and under gonadotrophin-releasing hormone agonist therapy", Human Reprod, 14, pp.2844~2850 (1999)
- Kawaguchi K, "Immunohistochemical analysis of estrogen receptors, progesterone receptors and Ki-67 in leiomyoma and myometrium during the menstrual cycle and pregnancy", Virchows Arch A Pathol Anat Histopathol, 419, pp.309~315 (1991)
- Ichimura T, "Correlation between the growth of uterine leiomyomata and estrogen and progesterone receptor content in needle biopsy specimens", Fertil Steril, 70, pp.967~971 (1998)
- Gökaslan H, "Differential diagnosis of smooth muscle tumors utilizing p53, pTEN and Ki-67 expression with estrogen and progesterone receptors", Gynecol Obstet Invest, 59, pp.36~40 (2005)
- Bodner K, "Estrogen and progesterone receptor expression in patients with uterine smooth muscle tumors", Fertil Steril, 81, pp.1062~1066 (2004)
- Herbert WW, "Percutaneous ultrasound guided uterine needle biopsy", Med J Aust, 159, pp.68~69 (1993)
- Kawamura N, "Transcervical needle biopsy for the differential diagnosis between uterine sarcoma and leiomyoma", Cancer, 94, pp.1713~1720 (2002)
- Klijanienko J, "Fine-needle aspiration of leiomyosarcoma: a correlative cytohistopathological study of 96 tumors in 68 patients", Diagn Cytopathol, 28, pp.119~125 (2003)