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子宫内膜异位症(EMs)中异位内膜周期性出血形成的病灶导致女性严重的盆腔疼痛与不孕。EMs是一种雌二醇(E2)依赖性疾病,孕酮是拮抗E2的经典药物。EMs患者血清孕酮水平正常,但子宫内膜对孕酮的反应性却明显下降,导致着床期子宫内膜容受性下降,不孕症发生率增加。在临床治疗中,多数EMs患者对孕酮治疗呈现低反应或无反应,这些都称为EMs的孕酮抵抗现象。孕酮抵抗机制涉及孕酮受体(PR)的缺陷,PR辅激活子的改变,基因和环境因素的变化以及雌激素受体亚型的改变等。综述有关EMs孕酮抵抗的相关机制,为克服EMs孕酮抵抗提供理论基础。
Ectopic endometrium in endometriosis (EMs) in the formation of lesions caused by severe pelvic pain and infertility in women. EMs is an estradiol (E2) -dependent disease and progesterone is a classical drug that antagonizes E2. The level of serum progesterone in patients with normal EMs, but the endometrial progesterone reactivity decreased significantly, resulting in impaired endometrial receptivity decreased, the incidence of infertility increased. In clinical treatment, most patients with EMs showed low or no response to progesterone treatment, which are all called progesterone resistance of EMs. Progesterone resistance mechanisms involve defects in progesterone receptor (PR), changes in PR coactivators, changes in genes and environmental factors, and changes in estrogen receptor subtypes. This review summarizes the relevant mechanisms of progesterone resistance in EMs and provides a theoretical basis for overcoming the progesterone resistance in EMs.