子宫内膜异位症患者免疫功能的变化

目的　为了探讨子宫内膜异位症发病的免疫机制。方法　采用间接免疫荧光法对子宫内膜异位症患者外周血中的 Ｔ细胞亚群、 Ｂ 细胞, Ｎ Ｋ 细胞及 Ｉ Ｌ－ ２ Ｒ＋ 细胞进行检测,并采用酶联免疫双抗体夹心法对子宫内膜异位症患者外周血及腹腔液中的 Ｔ Ｎ Ｆ－ α浓度进行了检测。结果　子宫内膜异位症患者外周血中 Ｔ 细胞亚群失衡、 Ｂ 细胞增多,外周血及腹腔液中的 Ｔ Ｎ Ｆ－ α浓度显著升高。结论　外周血中 Ｔ 细胞亚群失衡、 Ｂ 细胞增多,腹腔液中 Ｔ Ｎ Ｆα浓度升高可能与子宫内膜异位症的发生,发展密切相关。     

活血化瘀软坚散结法对子宫内膜异位症细胞免疫和体液免疫功能影响的实验研究

[目的]探讨妇痛宁颗粒剂治疗治疗子宫内膜异位症(EMS)的免疫学机制。[方法]采用手术移植法制备大鼠子宫内膜异位症模型。实验共分6组 ,实验结束检测各组大鼠外周血T细胞亚群、血清免疫球蛋白IgA、IgG、IgM、IgE和补体C3 改变。[结果]模型对照组与空白对照组比较CD3、CD4、CD8 有明显变化 ,各项结果均P<0.01。除丹那唑对CD4、妇痛宁低剂量组对CD8,其余各组治疗作用明显 ,疗后与空白对照组比较均P>0.05。模型对照组血中免疫球蛋白IgA、IgG、补体C3 较空白对照组显著上升 ,P<0.01。IgM亦上升 ,P<0.05。除妇痛宁低剂量组 ,各组疗后数值均处于正常水平 ,与空白对照组比较P>0.05。IgE在各组间无明显变化。[结论]活血化瘀、软坚散结法的代表方妇痛宁 ,对子宫内膜异位症免疫功能异常具有显著调整作用 ,并可能通过此途径达到治疗目的     

子宫内膜异位症患者血管内皮生长因子的测定

目的　探讨子宫内膜异位症 (内异症 )患者腹腔液及血清中血管内皮生长因子(VEGF)在内异症发病中的作用。方法　采用双抗体夹心酶联免疫吸附法 (ELISA) ,检测 35例内异症患者 (Ⅰ期和Ⅱ期 16例 ,Ⅲ期和Ⅳ期 19例 )和 2 0例非内异症患者 (对照组 )腹腔液及血清中VEGF的含量 ,分析VEGF浓度及其与内异症分期R -AFS的相关性。结果　内异症患者腹腔液及血清中VEGF的浓度明显高于对照组 (P <0 .0 1) ,2组腹腔液VEGF含量均高于同组的血清含量 (P <0 .0 5 ) ;Ⅲ期和Ⅳ期内异症患者腹腔液及血清VEGF含量明显高于Ⅰ期和Ⅱ期患者 (P <0 .0 1) ,其中增生期患者又明显高于分泌期患者 (P <0 .0 5 ) ;而内异症患者R -AFS分期与腹腔液及血清VEGF含量无明显相关 ,腹腔液与血清VEGF含量无相关。结论　内异症患者腹腔液中VEGF升高是腹腔微环境改变导致内异症的原因。     

益气活血方内服与灌肠治疗子宫内膜异位症的临床研究

[目的]探讨中药内服与灌肠治疗子宫内膜异位症的临床疗效。[方法]中药口服加灌肠组采用自拟益气活血、温通散瘀为治则的口服及灌肠中药综合治疗 ,并与口服中药组、丹那唑组对照比较 ,均连续治疗3个月。治疗前后观测子宫内膜异位症的症状、体征及B超检查。[结果]3组有效率及受孕率比较有显著性差异 (P<0.05) ,中药口服加灌肠组有效率及受孕率均优于口服中药组(P<0.05) ,受孕率优于丹那唑组 (P<0.05)。[结论]益气活血方内服与灌肠治疗子宫内膜异位症疗效满意。     

Tissue Inhibitor of Metalloproteinase-1 Concentrations are Attenuated in Peritoneal Fluid and Sera of Women with Endometriosis and Restored in Sera by Gonadotropin-Releasing Hormone Agonist Therapy

Objective: To establish tissue inhibitor of metalloproteinase-1 (TIMP-1) concentrations in peritoneal fluid (PF) and sera of women with endometriosis and compare them to disease-free controls.

Design: Prospective randomized study.

Setting: Academic medical center.

Patient(s): Women with laparoscopically documented endometriosis and disease-free women of reproductive age.

Intervention(s): Peritoneal fluid and sera were collected, and some women received gonadotropin-releasing hormone agonist (GnRH-a) therapy for endometriosis.

Main Outcome Measure(s): Peritoneal fluid and sera TIMP-1 concentrations were measured with a specific RIA.

Result(s): The TIMP-1 concentrations were significantly lower in PF and sera of women with endometriosis compared with disease-free women. The GnRH-a therapy restored serum TIMP-1 concentrations.

Conclusion(s): Aberrant expression and localization of TIMP-1 may derange the proteolytic milieu of the peritoneal cavity and contribute to the etiology and underlying physiologic sequelae associated with endometriosis. Measurement of TIMP-1 in serum may aid in diagnosing endometriosis and assist with monitoring treatment efficacy in women with this disease.     

Impact of Varying Stages of Endometriosis on the Outcome of In Vitro Fertilization–Embryo Transfer

Purpose: The impact of severity of endometriosis on the outcome of in vitro fertilization (IVF) was analyzed in an uncontrolled, retrospective study in an academic IVF program. Methods: Sixty-one patients with a primary diagnosis of endometriosis undergoing 85 cycles of IVF were included in the study. Patients were divided according to the severity of disease based on the revised American Fertility Society (AFS) classification into groups A (stages I/II, or minimal/mild) and B (stages III/IV, or moderate/severe). Group A included 32 patients undergoing 45 IVF-embryo transfer (ET) cycles; group B included 29 patients undergoing 40 IVF cycles. Exclusion criteria were age older than 40 years, basal day 3 follicle stimulating hormone (FSH) greater than 20 IU/L, male-factor infertility, assisted hatching, and gamete intrafallopian transfer cases. Stimulation for IVF cycles was standard using pituitary down-regulation with gonadotropin-releasing hormone agonist in a midluteal protocol. Controlled ovarian hyperstimulation (COH) was achieved using a combination of FSH and human menopausal gonadotropin. Outcomes assessed included response to COH and number, maturity, and quality of oocytes retrieved. Fertilization, implantation, and pregnancy rates after IVF-ET were also analyzed. Results: The response to COH and the number, maturity, and quality of the oocytes was comparable between patients with varying severity of endometriosis. Fertilization rates for oocytes of patients in group B (stages III/IV) were significantly impaired compared to those in group A (stages I/II) (P = 0,004). The rates for implantation, clinical pregnancy, and miscarriage were comparable between the two groups. Conclusions: The reduced fertilization potential of the oocytes obtained from patients with severe endometriosis in the absence of male-factor infertility suggests an adverse biological impact of the advanced disease on the oocytes. The outcome of IVF-ET, however, is unaffected by increasing severity of endometriosis. This suggests that IVF may compensate for or overcome this reduction in the biological potential of the oocytes associated with severe disease, thus accounting for a comparable outcome irrespective of the severity of endometriosis.     

会阴腹壁子宫内膜异位症的临床分析

目的:探讨会阴、腹壁子宫内膜异位症(内异症)的诊断和处理.方法:对该院1991～2002年收治的14例会阴、腹壁内异症病例进行回顾性分析.结果:根据临床表现及病理检查,14例均诊断正确.4例会阴内异症均有会阴撕裂或侧切史,10例腹壁切口内异症均有剖宫产史.发病潜伏期,30岁以前多在1年以内,30岁以上多在1年以上.会阴内异症完整切除3例,腹壁内异症完整切除10例,随访1～5年无复发.结论:根据典型的病史和体检,可以对会阴、腹壁内异症做出正确诊断;手术切除为主要治疗方法.     

子宫内膜异位症中单核-巨噬细胞分泌VEGF水平的研究

目的 :探讨单核 -巨噬细胞分泌血管内皮生长因子(VEGF)的水平在子宫内膜异位症(内异症)发病机制中的作用。方法 :采用酶联免疫吸附试验 ,检测20例内异症患者 (内异症组Ⅱ期2例 ,Ⅲ期8例 ,Ⅳ期10例 )、30例非内异症患者 (对照组 )外周血单核细胞及腹腔液巨噬细胞培养上清液中VEGF的含量。结果 :内异症组腹腔液巨噬细胞培养上清液中VEGF的含量高于对照组 (P<0.05),而外周血单核细胞培养上清液中VEGF的含量与对照组差别无统计学意义。各期内异症组外周血单核细胞及腹腔液巨噬细胞分泌VEGF的水平差别无统计学意义 ,与AFS -r评分无关。结论 :内异症患者主要通过腹腔液巨噬细胞分泌高水平的VEGF ,促进异位内膜的黏附、种植 ,VEGF的分泌水平与临床分期无关。     

腹腔镜手术治疗中重度内膜异位症的术后用药

目的　探讨中重度内膜异位症腹腔镜手术治疗后 ,加用内分泌治疗的必要性以及副作用。方法　 1 9位患者术后不用药 (A组 )、 1 9例加用人工合成孕激素治疗 (B组 ) ,1 8例促性腺激素释放激素激动剂(GnRH -a)治疗 (C组 ) ,比较三组患者术后复发、妊娠结局及用药副作用情况。结果　A组 1 5 8%复发 ,B组2 6 3%复发 ,C组 1 7 0 %复发 ,三组差异无显著性 (P >0 0 5 )。三组不孕患者妊娠情况差异无显著性 (P >0 0 5 )。B组 7例患者未完全闭经 ,C组全部闭经 ,B组及C组闭经时间分别为 (4 4 0± 2 3 7)d及 (4 0 0± 1 3 6 )d ,复潮时间分别为 (4 8 7± 2 6 6 )d及 (5 8 1± 1 7 4 )d ,两组间差异无显著性 (P >0 0 5 ) ,但B组患者闭经及复潮的发生更加不确定。B组患者以高雄激素症状为主 ,5例患者服药后声音变低钝 ,C组患者以低雌激素所至围绝经期征候为主 ,均于停药后恢复。结论　对于有生育要求的患者 ,手术者若能彻底地清除盆腔内膜异位病灶 ,术后可不用药。 6～ 1 2个月后未妊娠者 ,考虑用药及助孕治疗。孕激素类药物使用前应充分交代该药的副作用 ,特别注意特殊职业的患者