子宫内膜异位症患者腹膜病灶中神经蛋白基因产物9.5的表达及其临床意义

目的 探讨子宫内膜异位症(内异症)患者腹膜病灶中神经蛋白基因产物9.5(PGP9.5)的表达及其与内异症疼痛的关系.方法 应用免疫组化Envision二步法检测32例内异症患者(内异症组,其中伴与不伴疼痛者各16例)的腹膜病灶组织和同期行腹腔镜手术并经病理学检查确诊为子宫肌瘤且不伴疼痛者20例(对照组)的正常腹膜组织中PGP9.5的表达.结果 内异症组伴与不伴疼痛者腹膜病灶和对照组腹膜组织中PGP9.5表达阳性率及阳性神经纤维密度分别为62%(10/16)和(3.8±1.7)条/mm~2、19%(3/16)和(1.7±0.5)条/mm~2、25%(5/20)和(1.3±0.6)条/mm~2,内异症组伴疼痛者腹膜病灶中PGP9.5阳性神经纤维密度及阳性率均显著高于内异症组不伴疼痛者和对照组,差异均有统计学意义(P均<0.05);但内异症组不伴疼痛者腹膜病灶中PGP9.5阳性神经纤维密度及阳性率与对照组比较,差异均无统计学意义(P均>0.05).内异症组伴疼痛者腹膜病灶中PGP9.5阳性神经纤维密度与患者疼痛程度呈正相关关系(r=0.855,P<0.05).内异症组伴痛经和(或)慢性盆腔痛患者腹膜病灶中,PGP9.5阳性神经纤维密度显著高于伴其他疼痛类型者,差异也有统计学意义(P<0.05),但PGP9.5阳性神经纤维密度与病灶活性、病灶部位及疾病分期均无关(P均>0.05).结论 PGP9.5阳性神经可能参与内异症疼痛的发生机制.

Protein gene product 9.5-immunoactive nerve fibers and its clinical significance in endometriotic peritoneal lesions

Objective To investigate the association between distribution of protein gene product (PGP) 9.5-immunoactive nerve fibers in peritoneal endometriotic lesions and disease-associated pain symptoms.Methods Thirty two peritoneal endometriotic lesions from patients with endometriosis (16 cases with pain and 16 cases without pain) and matched with 20 peritoneal tissues from patients with uterine leiomyoma without endometriosis were stained immunohistochemically for PGPg.5-immunoactive nerve fibers.Results The positive rate and density of PGP9.5-immunoreactive nerve fibers in peritoneal endometriotic leision were 62% (10/16) and (3.8 ± 1.7)/mm~2 in endometriosis patients with pain, which were significantly higher than 19% (3/16) and (1.7 ± 0.5)/mm~2 in endometriosis patients without pain (P <0.05) and 25% (5/20) and (1.3±0.6) /mm~2 in peritoneal tissues in women without endometriosis (P <0.05).However, no differences were found between endometriosis patients without pain and women without endometriosis (P > 0.05) .Moreover, the density of PGP9.5-immunoreactive nerve fibers in peritoneal lesions in endometriosis patients with pain was positively correlated with the severity of pain (r = 0.855, P < 0.05).In addition, the density of PGP9.5-immunoreactive nerve fibers in peritoneal lesions was statistically higher in endometriosis patients with chronic pelvic pain and(or) dysmenorrhea than those in endometriosis patients with other type of pain(P < 0.05), which was not associated with active lesion, site and staging (P > 0.05).Conclusion It suggested that PGP9.5-immunoreactive nerve fibers might confer the mechanism of pelvic pain with endometriosis.