中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2014年
2期
120-124
,共5页
子宫腺肌病%神经生长因子%神经纤维植入%盆腔痛%痛经
子宮腺肌病%神經生長因子%神經纖維植入%盆腔痛%痛經
자궁선기병%신경생장인자%신경섬유식입%분강통%통경
Adenomyosis%Nerve growth factor%Innervation%Pelvic pain%Dysmenoreal
目的 探讨子宫腺肌病患者病灶神经生长因子(NGF)表达水平与神经纤维植入密度及盆腔疼痛的关系.方法 选择2009年3至10月在复旦大学附属妇产科医院因子宫腺肌病行子宫全切除的子宫腺肌病患者45例,根据有无疼痛分为疼痛组33例和无痛组12例,并根据视觉模拟评分法将子宫腺肌病患者按照不同疼痛部位及疼痛程度分为无痛、轻中度痛、重度痛.选择同期行子宫切除的子宫颈上皮内瘤变(CIN)Ⅲ级及子宫肌瘤患者26例为对照组.疼痛组和无痛组于术中取子宫腺肌病病灶,对照组取子宫内膜,分别行免疫组化SP法检测NGF蛋白表达水平,免疫荧光法检测蛋白基因产物(PGP)9.5阳性神经纤维密度.结果 疼痛组NGF蛋白表达水平为0.25±0.08、PGP9.5阳性神经纤维密度为(16±8)条/mm2,无痛组分别为0.19 ±0.05、(11±5)条/mm2,对照组分别为0.18 ±0.05、(9±4)条/mm2；疼痛组与无痛组和对照组分别比较,差异均有统计学意义(P均＜0.05).子宫腺肌病痛经重痛者NGF蛋白表达水平0.29±0.07、PGP 9.5阳性神经纤维密度(19±10)条/mm2,轻中度痛者分别为0.22 ±0.07、(13±4)条/mm2,无痛者分别为0.18 ±0.05、(11±5)条/mm2；痛经重度痛者与轻中度痛者、无痛者分别比较,差异均有统计学意义(P均＜0.05).结论 子宫腺肌病病灶NGF蛋白表达水平升高可能参与患者痛经的发生机制,促进病灶内膜神经纤维植入可能是其机制之一.
目的 探討子宮腺肌病患者病竈神經生長因子(NGF)錶達水平與神經纖維植入密度及盆腔疼痛的關繫.方法 選擇2009年3至10月在複旦大學附屬婦產科醫院因子宮腺肌病行子宮全切除的子宮腺肌病患者45例,根據有無疼痛分為疼痛組33例和無痛組12例,併根據視覺模擬評分法將子宮腺肌病患者按照不同疼痛部位及疼痛程度分為無痛、輕中度痛、重度痛.選擇同期行子宮切除的子宮頸上皮內瘤變(CIN)Ⅲ級及子宮肌瘤患者26例為對照組.疼痛組和無痛組于術中取子宮腺肌病病竈,對照組取子宮內膜,分彆行免疫組化SP法檢測NGF蛋白錶達水平,免疫熒光法檢測蛋白基因產物(PGP)9.5暘性神經纖維密度.結果 疼痛組NGF蛋白錶達水平為0.25±0.08、PGP9.5暘性神經纖維密度為(16±8)條/mm2,無痛組分彆為0.19 ±0.05、(11±5)條/mm2,對照組分彆為0.18 ±0.05、(9±4)條/mm2；疼痛組與無痛組和對照組分彆比較,差異均有統計學意義(P均＜0.05).子宮腺肌病痛經重痛者NGF蛋白錶達水平0.29±0.07、PGP 9.5暘性神經纖維密度(19±10)條/mm2,輕中度痛者分彆為0.22 ±0.07、(13±4)條/mm2,無痛者分彆為0.18 ±0.05、(11±5)條/mm2；痛經重度痛者與輕中度痛者、無痛者分彆比較,差異均有統計學意義(P均＜0.05).結論 子宮腺肌病病竈NGF蛋白錶達水平升高可能參與患者痛經的髮生機製,促進病竈內膜神經纖維植入可能是其機製之一.
목적 탐토자궁선기병환자병조신경생장인자(NGF)표체수평여신경섬유식입밀도급분강동통적관계.방법 선택2009년3지10월재복단대학부속부산과의원인자궁선기병행자궁전절제적자궁선기병환자45례,근거유무동통분위동통조33례화무통조12례,병근거시각모의평분법장자궁선기병환자안조불동동통부위급동통정도분위무통、경중도통、중도통.선택동기행자궁절제적자궁경상피내류변(CIN)Ⅲ급급자궁기류환자26례위대조조.동통조화무통조우술중취자궁선기병병조,대조조취자궁내막,분별행면역조화SP법검측NGF단백표체수평,면역형광법검측단백기인산물(PGP)9.5양성신경섬유밀도.결과 동통조NGF단백표체수평위0.25±0.08、PGP9.5양성신경섬유밀도위(16±8)조/mm2,무통조분별위0.19 ±0.05、(11±5)조/mm2,대조조분별위0.18 ±0.05、(9±4)조/mm2；동통조여무통조화대조조분별비교,차이균유통계학의의(P균＜0.05).자궁선기병통경중통자NGF단백표체수평0.29±0.07、PGP 9.5양성신경섬유밀도(19±10)조/mm2,경중도통자분별위0.22 ±0.07、(13±4)조/mm2,무통자분별위0.18 ±0.05、(11±5)조/mm2；통경중도통자여경중도통자、무통자분별비교,차이균유통계학의의(P균＜0.05).결론 자궁선기병병조NGF단백표체수평승고가능삼여환자통경적발생궤제,촉진병조내막신경섬유식입가능시기궤제지일.
Objective To investigate the expression of neive growth factor (NGF) in the ectopic endometrium in adenomyosis patients,and explore the relationship between NGF expression and innervation or pain scales.Methods From Mar.2009 to Oct.2009,45 adenomyosis patients undergoing hysterectomy in Obstetrics and Gynecology Hospital of Fudan University were enrolled in this study,which were classified into 33 cases in pain group and 12 cases in non-pain group based on symptom.The degree of dysmenoreal,chronic pelvic pain and dyspareunia was evaluated by visual analogue scale,including no pain,mild to moderate pain and severe pain group.In the mean time,26 patients with leiomyoma or cervical intraepithelial neoplasia Ⅲ (CIN Ⅲ)undergoing hysterectomy were defined as control group.Ectopic endometrium from experimental group and eutopic endometrium from control group were collected in the surgery.The expression of NGF was examined by immunohistochemistry.The density of protein gene product (PGP)9.5 positive nerve fibers was detected by immuno-fluorescence.Results The NGF level and the density of PGP 9.5 positive nerve fibers in adenomyosis pain group (0.25 ± 0.08,16 ± 8) were higher than adenomyosis painless (0.19 ± 0.05,P =0.007 ; 11 ± 5,P =0.018) and control group (0.18 ± 0.05,P =0.000;9 ± 4,P =0.000).The NGF level and the density of PGP9.5 positive nerve fibers in severe dysmenorrheal group(0.29 ± 0.07,19 ± 10) were higher than mild to moderate dysmenorrheal (0.22 ± 0.07,P =0.018 ; 13 ± 4,P =0.035) and painless group (0.18 ± 0.05,P =0.000 ; 11 ± 5,P =0.006) of adenomyosis patients.There was no difference of NGF level and the density of PGP 9.5 positive nerve fibers in chronic pelvic pain group and no chronic pelvic pain group of adenomyosis patients,so was dyspareunia group and no dyspareunia group.Conclusion The increased NGF level of adenomyosis nodules and improving innervation might be involved in the mechanism of adenomyosis related pain.
