OBJECTIVE To determine the relationship between steroid receptor expression and pain symptoms in endometriosis. DESIGN Cross-sectional SETTING: University Hospital PATIENT(S): Women with endometriosis (N = 92). INTERVENTION(S) Tissue samples were obtained from patients with surgically diagnosed endometriosis. MAIN OUTCOME MEASURE(S) A tissue microarray (TMA) was generated from patients with endometriosis. Data were collected on the presence and severity of dysmenorrhea, deep dyspareunia, dyschezia, and nonmenstrual pain by use of a numerical rating scale (NRS) at the time of surgery and after 1 year. The intensity of receptor expression was evaluated through immunohistochemistry and measured according to an immunoreactive score (IRS). Clinical variables were correlated to IRS by multivariate logistic regression analysis. RESULTS Estrogen receptor-α (ER-α), progesterone receptor (PR), androgen receptor (AR), and aromatase expression differed among study participants. ER-α expression was reduced by progestin therapy, whereas of expressions of PR, AR, and aromatase were unchanged. Higher ER-α expression increased the likelihood of moderate to severe dysmenorrhea and deep dyspareunia in women not receiving hormonal treatment. In women receiving progestin therapy, persistently higher ER-α expression was correlated with greater likelihood of deep dyspareunia, severe dyschezia, and endometriosis-associated pain persistence at 1 year. CONCLUSION(S) ER-α, PR, AR, and aromatase were all expressed in deep endometriosis. ER-α levels best correlated with severity of symptoms, which suggests that ER is a key driver of deep endometriosis. Progestin treatment was associated with a reduction of ER-α expression; however, failure of ER suppression by progestins was also a predictor of pain severity and recurrence at 1 year.

中文翻译：

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雌激素受体-α免疫反应性预测深部子宫内膜异位症的症状严重程度和疼痛复发

目的探讨类固醇受体表达与子宫内膜异位症疼痛症状的关系。设计横断面设置：大学医院患者：患有子宫内膜异位症的女性（N = 92）。干预 从手术诊断为子宫内膜异位症的患者中获得组织样本。主要结果测量从子宫内膜异位症患者产生组织微阵列（TMA）。使用数字评定量表 (NRS) 在手术时和 1 年后收集有关痛经、深度性交痛、排便困难和非经期疼痛的存在和严重程度的数据。通过免疫组织化学评估受体表达的强度，并根据免疫反应评分（IRS）进行测量。通过多变量逻辑回归分析将临床变量与 IRS 相关联。结果 研究参与者的雌激素受体-α (ER-α)、孕激素受体 (PR)、雄激素受体 (AR) 和芳香酶表达不同。ER-α 表达被孕激素治疗降低，而 PR、AR 和芳香酶的表达没有变化。在未接受激素治疗的女性中，较高的 ER-α 表达增加了中度至重度痛经和深度性交痛的可能性。在接受孕激素治疗的女性中，持续较高的 ER-α 表达与 1 年内发生深度性交痛、严重排便困难和子宫内膜异位症相关疼痛的可能性更大相关。结论（S）ER-α、PR、AR和芳香化酶均在深部子宫内膜异位症中表达。ER-α 水平与症状的严重程度最相关，这表明 ER 是深部子宫内膜异位症的关键驱动因素。孕激素治疗与 ER-α 表达降低有关；然而，孕激素抑制 ER 的失败也是疼痛严重程度和 1 年复发的预测因素。