子宫内膜异位症不孕患者腹腔液淋巴细胞转化活性及可溶性白细胞介素-2受体的含量

本文采集了15例子宫内膜异位症不孕患者及13例健康生育妇女的腹腔液，分别测定腹腔液淋巴细胞转化活性及淋巴细胞培养上清液中可溶性白细胞介素-2受体（SIL－2R的含量。结果表明，子宫内膜异位症不孕患者淋巴细胞转化活性增强，SIL－2R含量增加。这些变化可能与异位症不孕的发生密切相关。     

子宫内膜异位症不孕患者腹腔液淋巴细胞转化活性及可溶性白细胞…

本文采集了１５例子宫内膜异位症不孕患者及１３例健康生育妇女的腹腔液，分别测定腹腔液淋巴细胞转化活性及淋巴细胞培养上清液中可溶性白细胞介素－２受体（ＳＩＬ－２Ｒ的含量。结果表明，子宫内膜异位症不孕患者淋巴细胞转化活性增强，ＳＩＬ－２Ｒ含量增加。这些变化可能与异位症不孕的发生密切相关。     

子宫内膜异位症患者腹腔液中白细胞介素-8的测定

子宫内膜异位症是生育期妇女常见疾病，其发病机理至今尚不清楚。目前，免疫学说已引起人们的注意。大量研究表明，子宫内膜异位症的免疫变化与细胞因子密切相关。卵泡液、腹腔液及血液中白细胞介素１（ＩＬ１）、白细胞介素２（ＩＬ２）、白细胞介素６（ＩＬ?..     

输卵管子宫内膜异位症的研究进展

输卵管子宫内膜异位症（tubal endometriosis,TEM）是指子宫内膜异位在输卵管组织上。因其发病率较低,且症状不特异,诊断仅依靠术后病理,相关研究较为欠缺;但TEM发病率近年来明显上升,其对机体造成的影响及社会影响不可忽视,也引起了更多关注。近年来对TEM的研究,如TEM的临床症状、诊断与治疗方法,及其发病机制,包括对输卵管结构和功能的影响、TEM与不孕症和癌症的关系等,都取得了一定的进展。TEM的研究既有利于TEM本身发病机制的明确、诊断分期标准的确立和精准治疗方案的制定,也将为子宫内膜异位症和输卵管性不孕症等疾病的治疗提供思路。结合文献报道,对TEM的研究现状综述如下。     

白细胞介素1与子宫内膜异位症发生机制

细胞因子在子宫内膜异位症（EMs）的发生、发展中起着重要的作用，白细胞介素1（IL-1）系统在细胞因子网络中占有重要地位，通过调节其他细胞因子和甾体激素的合成与分泌，对病灶部位的炎症反应和逆流到腹腔的内膜细胞的黏附、侵袭和血管形成过程发挥重要的调节作用。深入研究IL-1系统的调节机制将为寻求新的治疗方法提供思路。     

子宫内膜异位症患者腹腔液白细胞介素6、8及转化生长因子β1的测定

目的　探讨腹腔液中细胞因子在子宫内膜异位症 (内异症 )发病中的作用。方法　采用酶联免疫吸附试验 ,检测 31例内异症患者 (Ⅰ、Ⅱ、Ⅲ期各 8例 ,Ⅳ期 7例 )、2 2例非内异症患者 (对照 )腹腔液中白细胞介素 6 (IL 6 )、白细胞介素 8(IL 8)及转化生长因子 β1(TGF β1)的含量 ;并对内异症患者腹腔液中细胞因子浓度与美国生育协会修正标准分期 (R AFS)及痛经评分进行相关性分析。结果　内异症患者腹腔液中IL 6及IL 8含量 [( 1.8± 0 .4)ng/L ,( 1.7± 0 .5 )ng/L]明显高于对照者 [( 1.2±0 .2 )ng/L ,( 1.4± 0 .3)ng/L ,P <0 .0 5 ];TGF β1含量两者比较 ,差异无显著性 (P >0 .0 5 )。IL 6与R AFS评分有显著相关性 (P <0 .0 5 )。 3个细胞因子与痛经评分均无相关性 (P >0 .0 5 )。结论　内异症患者腹腔液中异常水平的IL 6及IL 8是腹腔免疫动态环境失衡的部分原因     

白细胞介素与子宫内膜异位症

子宫内膜异位症是妇科常见疾病，近年来发病率明显升高。在因不孕行腹腔镜检查的患者中，12％-48％有内膜异位症存在。子宫内膜异位症是一种良性过程，它以子宫内膜组织在宫腔外附着与生长为特征，这种异位内膜具有生长、浸润，甚至类似恶性组织的播散能力，同时也是一种非感染性疾病，但它具有类似炎症的纤维化、粘连形成等反应。     

米非司酮和孕酮对子宫内膜异位症患者子宫内膜白细胞介素6分泌的影响

目的探讨米非司酮和孕酮对子宫内膜异位症(内异症)患者异位子宫内膜(异位内膜)与正常子宫内膜(在位内膜)白细胞介素6(IL-6)分泌的影响.方法采用酶联免疫吸附试验(ELISA)方法,检测米非司酮浓度为1×10-6mol/L(米非司酮1组)、1×10-4mol/L(米非司酮2组),和孕酮浓度为1×10-7mol/L(孕酮1组)、1×10-5mol/L(孕酮2组)与体外培养的异位内膜细胞和在位内膜细胞上清液作用后的IL-6水平.结果米非司酮可降低异位内膜细胞IL-6水平,米非司酮1组和米非司酮2组的IL-6分为(1914.33±799.28)μg/L和(990.25±58.40)μg/L,两组与空白组比较(下同),差异有极显著性(P＜0.01).孕酮也可降低异位内膜细胞IL-6水平,孕酮1组和孕酮2组的IL-6分为(2575.89±119.75)μg/L和(1736.25±750.89)μg/L(P＜0.01).米非司酮还可使在位内膜细胞IL-6水平降低,其中米非司酮1组和米非司酮2组分别为(346.96±24.32)μg/L和(270.22±36.15)μg/L(P＜0.01).孕酮对在位内膜细胞IL-6水平无明显影响(P＞0.05).结论米非司酮和孕酮可抑制异位内膜和在位内膜细胞IL-6的分泌.     

子宫内膜异位症不孕的腹腔巨噬细胞及其释放白细胞介素 I(IL-1)的活性改变

本文以18例轻度子宫内膜异位症不孕者作为研究对象;以正常生育力的妇女10例作为对照。检测各例腹腔液量、腹腔巨噬细胞(MΦ)数、巨噬细胞吞噬能力及腹腔液、巨噬细胞培养上清液IL-1活性。研究结果:轻度子宫内膜异位症不孕者比正常生育对照妇女腹腔巨噬细胞数量增多,对白色念珠菌的吞噬指数及吞噬百分率增高,腹腔液及巨噬细胞培养上清液IL-1活性增强。研究表明,子宫内膜异位症不孕者腹腔巨噬细胞及其释放的IL-1均有改变,MΦ及IL-1可能是不孕的因素。     

子宫内膜异位症生育指数对人工授精治疗EMs相关性不孕的预测价值

目的：探讨子宫内膜异位症生育指数（EFI）对子宫内膜异位症（EMs）相关性不孕患者腹腔镜术后行宫腔内人工授精（IUI）助孕临床妊娠率的预测作用。方法：收集2008年1月—2014年4月在广州市第一人民医院生殖健康与不孕症专科就诊的75例EMs不孕患者125个IUI周期的资料,按照EFI评分标准计算EFI,利用受试者工作特征曲线（ROC曲线）分析EFI对IUI临床妊娠率的预测价值。结果：EFI评分预测IUI临床妊娠率的ROC曲线下面积为0.708±0.059,大于机会参考线下面积（P＜0.05）;诊断界值点为7分,敏感度为0.737,特异度为0.613;美国生育协会修订的EMs分期（r-AFS分期）预测IUI临床妊娠率的ROC曲线下面积为0.375±0.065（P＞0.05）,不具有诊断意义。EFI≤6分的周期患者IUI临床妊娠率为3.1%,EFI为7、8、9、10分的周期患者IUI临床妊娠率分别为10.5%、21.1%、27.8%、27.8%,EFI为8、9、10分的周期患者临床妊娠率高于EFI≤6分的周期,差异有统计学意义（P＜0.05）。结论：EFI可以有效预测EMs相关性不孕患者腹腔镜术后IUI的临床妊娠率,EFI≥8分的患者IUI临床妊娠率明显升高,可为EMs相关性不孕患者腹腔镜术后辅助生殖技术的选择提供参考依据。     

子宫内膜异位症患者腹腔液白细胞介素17水平的变化及其意义

目的探讨白细胞介素17(IL17)与子宫内膜异位症(内异症)发病的关系。方法应用酶联免疫吸附(ELISA)法检测36例不同期别内异症患者(内异症组)和26例非内异症患者(对照组)腹腔液中的IL17水平。结果内异症组和对照组腹腔液IL17水平分别为(5.7±1.9)ng/L和(5.3±1.4)ng/L,两组比较,差异无统计学意义(P>0.05)。按1985年美国生育学会内异症分期标准(rAFS)进行分期,Ⅰ～Ⅱ期内异症患者(16例)腹腔液IL17水平为(6.4±1.7)ng/L,Ⅲ～Ⅳ期内异症患者(20例)为(5.1±1.8)ng/L,两者比较,差异有统计学意义(P<0.05)。卵泡期和黄体期腹腔液IL17水平在两组间比较,差异均无统计学意义(P>0.05)。内异症不孕患者腹腔液IL17水平为(6.4±1.8)ng/L,内异症未合并不孕患者为(5.1±1.8)ng/L,两者比较,差异有统计学意义(P<0.05)。结论IL17水平变化可能与早期内异症及内异症不孕的发病有关。     

子宫内膜异位症伴不孕几种治疗方法疗效的比较

目的 :比较子宫内膜异位症伴不孕不同治疗方法的疗效。方法 :197例患者中Ⅰ期 85例 (4 3.1% ) ,Ⅱ期 6 5例 (33.0 % ) ,Ⅲ期 2 8例 (14 .2 % ) ,Ⅳ期 19例 (9.6 % )。将Ⅰ、Ⅱ期患者分为 7组 ,分别采用三苯氧胺、米非司酮、丹那唑、诺雷德、10 0℃以下异位病灶热破、安慰剂治疗 (每组 2 1± 1例 ) ;下余 1组与Ⅲ、Ⅳ期患者采用两阶段复合治疗 ,即先破坏子宫内膜异位病灶 ,切除卵巢囊肿 ,分离粘连 ;再用丹那唑治疗 6个月。观察 1年并进行比较。结果 :Ⅰ、Ⅱ期患者用三苯氧胺、米非司酮、丹那唑、诺雷德、热破、两阶段复合治疗、安慰剂治疗 ,其受孕率分别为 34%、38%、5 4%、5 2 %、4 2 %、5 2 .6 %、8.1% ;Ⅲ、Ⅳ期患者治疗后的受孕率分别为 4 5 .6 %、4 8.7%。妊娠率动态分析显示最易受孕的时间是在治疗完成后的 6～ 8个月。结论 :子宫内膜异位伴不孕症不论其病情发展程度 ,都须积极治疗。最佳的治疗方法是用促性腺制剂及两阶段复合治疗。治疗后的最佳观察期限为12个月     

子宫内膜异位症生育指数与相关不孕患者腹腔镜术后妊娠的相关性

目的 评价子宫内膜异位症(内异症)生育指数与内异症不孕患者腹腔镜术后妊娠的相关性.方法 回顾性分析2005年1月至2010年1月350例行腹腔镜手术治疗的内异症相关不孕患者的病史及手术资料,电话随访其术后的妊娠情况.按照内异症生育指数的评分标准计算生育指数,利用Kaplan-Meier生存分析法计算不同分值患者的累积妊娠率,并进行比较.结果 内异症生育指数8、9、10分患者术后36个月的累积妊娠率分别为62.5％、69.8％、81.1％,3者间比较,差异无统计学意义(P=0.24);5、6、7分患者术后36个月累积妊娠率分别为49.8％、43.9％、41.6％,3者间比较,差异也无统计学意义(P=0.83).但8～10分患者术后36个月的总累积妊娠率为71.8％,5～7分患者为44.4％,两者比较,差异具有统计学意义(P=0.000).0～4分患者例数较少(共33例),其中15例妊娠.结论 内异症生育指数与内异症相关不孕患者腹腔镜术后的妊娠率相关.内异症生育指数对指导术后处理的选择且有重要的临床意义.     

Effect of peritoneal fluid from patients with minimal/mild endometriosis on progesterone release by human granulosa-lutein cells obtained from infertile patients without endometriosis: a pilot study

OBJECTIVE: To evaluate the effect of peritoneal fluid (PF) from women without and with minimal/mild endometriosis on progesterone (P) release by cultured human granulosa-lutein cells obtained from infertile patients without endometriosis submitted to ovarian hyperstimulation for in vitro fertilization (IVF). STUDY DESIGN: A pilot study was performed. Human granulosa-lutein cells, obtained from 11 infertile patients without endometriosis (tubal or male factors of infertility) submitted to ovarian hyperstimulation for IVF, were cultured without PF (basal production) and with increasing volumes of steroid-extracted PF samples from 11 patients with endometriosis and 11 patients without endometriosis. Progesterone (P) levels in the media after 72 h culture were measured by chemoluminescence assay. The non-parametric Mann-Whitney-test was used for statistical analysis. RESULTS: PF from patients without endometriosis stimulated P release in a dose-dependent manner up to the dose of 100 microl/ml (10% concentration) when compared with basal production (without adding PF). P release was similar in cultures stimulated with PF from patients with or without endometriosis at 1% (10 microl/ml) and 5% (50 microl/ml) concentrations. At 10% concentration, there was a non-statistically significant reduction in progesterone release by granulosa cells stimulated with PF from patients with endometriosis. PF from patients with endometriosis significantly reduced P release at 30% concentration (300 microl/ml). CONCLUSIONS: PF stimulates P release by human granulosa-lutein cells in a dose-dependent manner. However, higher concentrations of PF from patients with minimal/mild endometriosis reduce P release, suggesting it contains factors that may compromise ovarian steroidogenesis.     

促性腺激素释放激素激动剂用于治疗子宫腺肌病伴不孕症的观察

目的 探讨促性腺激素释放激素激动剂在治疗子宫腺肌病伴不孕症中的作用。方法 ４例有严重痛经的子宫腺肌病伴不孕症患者经Ｂ超及腹腔镜或病理检查确诊,在腹腔镜检查的同时手术矫治合并存在的子宫内膜异位症和盆腔粘连。４例中,３例子宫后壁有局限性腺肌瘤形成（其中２例在腹腔镜下行手术切除）。３例于术后,１例于术前注射长效缓释型ＧｎＲＨ－α,每月１次,共６次。结果 ＧｎＲＨ－α用药期间４例均闭经,血雌二醇于用药的第     

Diagnostic laparoscopy,infertility, and endometriosis—5 years experience

The objectives of this study were to determine the importance of diagnostic laparoscopy for the accurate diagnosis of endometriosis and to correlate the findings with infertility. Participants in this study included 336 women who were 18–45 years old, had no past medical history of abdominal operations, and complained of chronic symptoms of pelvic pain. In all these cases there were no pathological pelvic ultrasound findings. Also, nongynaecological diseases where excluded. Diagnostic laparoscopy was performed in all patients. In 191 women (56.8%) no pathology was found during the diagnostic laparoscopy, and 89 women (26.4%) actually reported improvement or even complete cure from their symptoms after the operation. In the majority of pathological cases the laparoscopy revealed various stages of endometriosis (n = 101; 30%). Other gynecological causes which were diagnosed during the laparoscopy where pelvic adhesions due to inflammatory disease (n = 37; 11%), ovarian cysts (n = 5; 1.5%), and uterine fibroids (n = 2; 0.5%). Diagnostic laparoscopy is the most accurate method for excluding the pathology related with chronic pelvic pain. Endometriosis seems to be responsible for the majority of pathological cases. Almost 60% of women have no pathology when examined with laparoscopy. A high percentage of symptoms can be phycogenic.     

Angiogenic activity and IL-8 concentrations in peritoneal fluid and sera in endometriosis.

OBJECTIVES: During menstruation endometrial fragments are transported into the peritoneal cavity where they form endometriotic lesions. Angiogenesis is proposed as one of the mechanisms in endometriosis pathogenesis. The aim of the study was to determine the angiogenic activity and interleukin 8 concentrations in peritoneal fluid and sera in endometriosis. METHODS: Angiogenesis was determined in cutaneous assay in Balb/c mice; IL-8 concentrations were measured by ELISA test in sera and peritoneal fluid of 32 control and 56 endometriosis patients. Wilcoxon and Mann-Whitney tests and Spearman rank correlations were used in statistical analysis. RESULTS: Peritoneal fluid and sera from the examined group had higher angiogenic activity and interleukin 8 concentrations. There was correlation found between AFS and neovascularization induced by sera and PF of patients with peritoneal lesions. CONCLUSIONS: Angiogenesis plays an important role in pathogenesis of endometriosis. Although IL-8 takes part in neovascularization, there are other factors modulating angiogenesis in endometriosis.     

子宫内膜异位症在位、异位内膜淋巴细胞亚群分布的研究

目的探讨子宫内膜异位症（内异症）在位和异位内膜淋巴细胞的分布及意义。方法采用免疫组织化学碱性磷酸酶抗碱性磷酸酶法,对43例内异症患者和19例子宫肌瘤等非内异症患者(对照组)的在位内膜和异位内膜中淋巴细胞及巨噬细胞亚群的数量、比例进行测定。结果内异症患者的增殖期异位内膜局部CD+3、CD+8、CD+68T淋巴细胞含量分别为（67.2±13.5）个/5HP（±s,下同）、（45.0±14.6）个/5HP、（37.2±10.6）个/5HP,明显多于在位内膜的（52.4±11.3）个/5HP（P<0.01）、（32.5±10.0）个/5HP（P<0.05）、（30.7±10.3）个/5HP,以及对照组内膜的（52.1±14.9）个/5HP（P<0.05）、（28.9±12.7）个/5HP（P<0.01）、（26.3±9.3）个/5HP（P<0.05）;分泌期CD+8T淋巴细胞/CD+4T淋巴细胞比值、CD+68T淋巴细胞含量分别为3.5±1.2、（40.3±12.2）个/5HP,高于对照组内膜的3.2±0.8（P<0.05）、（28.6±10.6）个/5HP（P<0.01）;巨噬细胞含量也明显增高。异位内膜中淋巴细胞无明显周期性改变。结论内异症病变局部淋巴细胞和巨噬细胞的大量侵润,与内异症的病理形成有关。在较晚期的内异症,淋巴细胞和巨噬细胞不能清除异位内膜,反之,可刺激其生长。     

Soluble serum interleukin-2 receptor,interleukin-6 and interleukin-1a in patients with endometriosis and in controls

The aim of this study was to verify to what extent danazol alters cell-mediated immunity. To this end, cell-mediated immunity was studied in 10 infertile patients with endometriosis and in 10 normal controls. Nonspecific parameters studied included serum SIL-2R, IL-6 and IL-1a levels. We also investigated the effect of treatment with Danazol on the levels of SIL-2R, IL-6 and IL-1a in women with endometriosis. Blood SIL-2R, IL-6 and IL-1a levels were measured in endometriotic women before treatment, during the last fifteen days of a 6-months course of Danazol and three months after treatment. Only one blood sample was taken from 10 women without endometriosis. SIL-2R, IL-6 and IL-1a levels were higher in women with endometriosis before treatment compared with controls. Administration of the drug significantly reduced the levels of SIL-2R (P<0.001), IL-6 (P<0.05) and IL-1a (P<0.01). Our findings suggest that endometriosis is a condition which induces a rise in interleukin levels. Danazol also appears significantly to reduce endometriosis — associated autoimmune abnormalities.