| 摘要: |
| 目的研究子宫腺肌病患者宫骶韧带及输卵管峡部神经损伤情况及血清IL-10水平，为子宫腺肌病的发病机制研究提供新的思路。方法选取因子宫腺肌病行腹腔镜下全子宫+双侧输卵管切除术的33例患者作为实验组，同期因子宫颈上皮内肿瘤III级及子宫肌瘤行相同手术的32例患者作为对照组，拍摄并记录两组患者腹腔镜下宫骶韧带形态学改变，测定宫骶韧带及输卵管峡部蛋白基因产物9.5（PGP9.5）表达情况，并采用ELISA法测定两组患者血清IL-10水平。结果实验组患者宫骶韧带在腹腔镜下表现为不同程度的损伤及中断，输卵管峡部黏膜层和肌层PGP9.5表达的阳性率及神经纤维密度较对照组明显减少（均P＜0.05）。两组患者输卵管浆膜层PGP9.5表达的阳性率及神经纤维密度比较差异均无统计学意义（均P＞0.05）。两组患者宫骶韧带PGP9.5表达的阳性率比较差异有统计学意义（P＜0.05），实验组患者在血管壁周围可见异常增生的神经纤维和血管壁增厚及管腔狭窄。实验组患者血清IL-10水平较对照组明显上升（P＜0.05）。结论子宫腺肌病患者宫骶韧带神经、输卵管近端黏膜层及肌层处神经即宫骶韧带上行的神经通路出现不同程度的损伤，且血清IL-10水平明显升高，盆腔神经损伤与炎症相互作用可能与子宫腺肌病的发生、发展相关。 |
| 关键词: 子宫腺肌病 宫骶韧带 神经纤维 神经损伤 IL-10 |
| DOI：10.12056/j.issn.1006-2785.2017.39.21.2017-548 |
| 分类号: |
| 基金项目:温州市公益性科技计划项目（Y20140743） |
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| Injury of pelvic nerves and serum level of IL-10 in patients with adenomyosis |
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the First Affiliated Hospital of Wenzhou Medical University
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| Abstract: |
| Objective To investigate the damage of pelvic nerves and the serum levels of IL-10 in patients with adenomyosis. Methods Histological sections of the uterosacral ligaments and the isthmus of fallopian tubes were obtained from women undergoing hysterectomy for adenomyosis (adenomyosis group, n=33) and leiomyoma or cervical intraepithelial neoplasia III (CIN III) (non-adenomyosis group, n=32). The expression of protein gene product 9.5(PGP 9.5) in uterosacral ligaments and the isthmus of fallopian tube was immunohistochemically analyzed. The distribution of nerve fibers in the uterosacral ligaments and the isthmus of fallopian tube was examined microscopically. Serum IL-10 levels were determined by enzyme linked immunosorbent assay (ELISA) in two groups. Results Varying degrees of injuries and interruptions of the uterosacral ligaments were noted in the adenomyosis patients and there was strong evidence of neovascularization of the peritoneal surfaces over the ligament, adjacent peritoneum and mesosalpinx. The expression of PGP 9.5 and the density of nerve fibers in the mucosal and muscular layers of
fallopian tubes were significantly decreased in adenomyosis (all P＜0.05). The nerve fibers stained with PGP 9.5 in the serous layer
of the fallopian tube among the two groups showed no significant difference(both P ＞0.05). The nerve fibers were decreased in the uterosacral ligaments of adenomyosis group compared with non-adenomyosis group (P＜0.05). The abnormal hyperplasia of the nerves was observed and the surrounded injured arterioles had thickened vessel walls and narrowed vascular cavity in adenomyosis group. The level of serum IL-10 in patients with adenomyosis was significantly higher than that in non-adenomyosis patients (P＜0.05). Conclusion Varying degrees of injuries to the nerves in the uterosacral ligaments and in the mucosal and muscular layers of fallopian tubes are noted in the adenomyosis patients. There is significantly abnormal serum IL-10 in patients with adenomyosis, which indicates that the interaction between pelvic nerve injury and inflammation may be responsible for the disease development. The results may providea novel insight into the pathogenesis of adenomyosis. |
| Key words: Adenomyosis Uterosacral ligament Nerve fibers Injured nerve IL-10 |
