血小板及相关因子功能的异常与子宫内膜异位症发病机制的关系

子宫内膜异位症是妇科的常见病及多发病,其是一种良性的慢性疾病,影响着10%~15%的育龄女性,其症状主要表现为痛经、盆腔粘连及不孕,其发病机制已有许多的假说但尚未认识清楚。近年来国内外学者相继发现血小板在子宫内膜异位症发病中具有重要的作用,主要表现子宫内膜异位症患者的血小板黏附、聚集功能存在缺陷,子宫内膜异位症患者的血小板计数升高,其血液处于相对高凝状态,并能介导炎症反应,血小板相关因子如P-选择素、CD40L、血小板生长因子在子宫内膜异位症的发病中起到不同程度的促进作用,而且血小板能够影响子宫内膜异位症患者体内的雌激素及其受体的表达,因此综述血小板功能上的异常与子宫内膜异位症的发病机制之间可能存在的联系,为临床上应用血小板来诊治子宫内膜异位症提供理论依据。     

自身抗体与子宫内膜异位症关系的研究进展

子宫内膜异位症（endometriosis,EMs）是育龄期妇女常见的良性疾病,但具有侵袭、种植及复发等恶性倾向,主要表现为痛经、月经紊乱、性交痛等,与不孕关系密切,其发病机制尚不明确。近年来多数研究认为,子宫内膜异位症是一种自身免疫性疾病,自身免疫反应在其发病机制中可能起一定作用。检测自身抗体可能为子宫内膜异位症的早期诊断提供新的辅助指标。     

自身抗体与子宫内膜异位症关系的研究进展

子宫内膜异位症(endometriosis,EMs)是育龄期妇女常见的良性疾病,但具有侵袭、种植及复发等恶性倾向,主要表现为痛经、月经紊乱、性交痛等,与不孕关系密切,其发病机制尚不明确。近年来多数研究认为,子宫内膜异位症是一种自身免疫性疾病,自身免疫反应在其发病机制中可能起一定作用。检测自身抗体可能为子宫内膜异位症的早期诊断提供新的辅助指标。     

子宫内膜异位症相关恶变的研究近况

子宫内膜异位症是一类常见的妇科疾病,其发病率为6%～10%。虽然为良性疾病,但有恶变风险,卵巢子宫内膜异位囊肿恶变率约为1%。目前关于子宫内膜异位症相关恶变的病因及发病机制尚不清楚。许多研究提示了子宫内膜异位症与恶性肿瘤密切相关,并认为子宫内膜异位症是卵巢癌的高危因素。流行病学研究显示,初诊年龄大、囊肿直径大、不孕及肥胖等会增加其恶变风险,生育次数多、子宫内膜异位病灶清除术、患侧附件切除术以及长期服用避孕药等可降低此风险。基础研究显示,氧化应激与抗氧化防御、炎症反应、激素作用、环境因素及基因突变等因素与其恶变机制关系密切。此文主要对子宫内膜异位症相关恶变的发病风险、高危因素、保护因素和发病机制4方面的进展进行归纳与总结,有助于进一步了解该疾病。     

子宫内膜异位症相关恶变的研究近况

子宫内膜异位症是一类常见的妇科疾病,其发病率为6%～10%。虽然为良性疾病,但有恶变风险,卵巢子宫内膜异位囊肿恶变率约为1%。目前关于子宫内膜异位症相关恶变的病因及发病机制尚不清楚。许多研究提示了子宫内膜异位症与恶性肿瘤密切相关,并认为子宫内膜异位症是卵巢癌的高危因素。流行病学研究显示,初诊年龄大、囊肿直径大、不孕及肥胖等会增加其恶变风险,生育次数多、子宫内膜异位病灶清除术、患侧附件切除术以及长期服用避孕药等可降低此风险。基础研究显示,氧化应激与抗氧化防御、炎症反应、激素作用、环境因素及基因突变等因素与其恶变机制关系密切。此文主要对子宫内膜异位症相关恶变的发病风险、高危因素、保护因素和发病机制4方面的进展进行归纳与总结,有助于进一步了解该疾病。     

孕宝治疗子宫内膜异位免疫不孕症141例疗效分析

子宫内膜异位症 (ｅｎｄｏｍｅｔｒｉｏｓｉｓ,ＥＭ ) ,是指具有生长功能的子宫内膜组织出现在子宫腔被覆粘膜以外的身体其它部位 ,引起一系列病症。ＥＭ是妇科常见病 ,多见于生育年龄女性 ,常引起不孕 ,在妇科剖腹手术中 ,ＥＭ约占 5 %～15 % ;在女性不孕中 ,ＥＭ约占 30 %～ 40 % ,且发病率近年明显增多[1] 。大量研究表明 ,子宫内膜异位症患者常伴有局部及全身细胞和体液免疫功能异常 ,主要表现为免疫细胞数量及功能异常 ,自身抗体产生 ,细胞因子含量及活性改变等 ,尤其是抗子宫内膜抗体 (ＥＭ -Ａｂ)对子宫内膜异位症的发病及不孕具有重…     

巨噬细胞与子宫内膜异位症

子宫内膜异位症(endometriosis,EMs)是妇科常见病,发病机制和病理过程目前不明确。通过测定子宫内膜异位症患者与对照组的腹腔液、在位及异位内膜组织中巨噬细胞数量及各种免疫因子的变化,发现子宫内膜异位症患者腹腔液、卵巢巨噬细胞及其代谢产物浓度增高,活性增强。证实巨噬细胞可能影响卵巢功能并在子宫内膜异位症的发生和发展过程中起重要作用。     

巨噬细胞与子宫内膜异位症

子宫内膜异位症(endometriosis,EMs)是妇科常见病,发病机制和病理过程目前不明确.通过测定子宫内膜异位症患者与对照组的腹腔液、在位及异位内膜组织中巨噬细胞数量及各种免疫因子的变化,发现子宫内膜异位症患者腹腔液、卵巢巨噬细胞及其代谢产物浓度增高,活性增强.证实巨噬细胞可能影响卵巢功能并在子宫内膜异位症的发生和发展过程中起重要作用.     

NDRG1在子宫内膜异位症中的潜在功能

正子宫内膜异位症(endometriosis,EMS)是指具有生长功能的子宫内膜组织(腺体和间质)出现在子宫腔以外的部位浸润生长所致的疾病。研究发现,10%~15%育龄期妇女会发生子宫内膜异位症,其中50%合并有不孕症,严重影响患者的生活质量~([1])。目前关于子宫内膜异位症发生及发展学说众多,最广为接受的为经血逆流"种植学说",近年来,郎景和等学者在此基础上又提出了"在位内膜决定论",认为子宫内膜异位症患者在位子宫内膜的生物学特性在其发病过程中起重要作用。子宫     

子宫内膜异位症和子宫腺肌病与复发性流产

子宫内膜异位症和子宫腺肌病是妇科常见疾病。越来越多的证据表明,这两种疾病对生殖功能有重要影响。临床可表现为不孕不育和流产等,尤其是早期流产。子宫内膜异位症引起流产的原因主要有疾病导致的内分泌功能异常、子宫内膜容受性降低和免疫因素等。子宫腺肌病导致流产的机制主要是子宫螺旋动脉重塑受损和子宫结合带结构功能异常。临床应注重自然流产患者子宫内膜异位症和子宫腺肌病的有关筛查与诊断,并在下次妊娠前给予积极的治疗。     

Serum and peritoneal abnormalities in endometriosis: potential use as diagnostic markers

Endometriosis is an ambiguous disease and its exact pathogenesis still remains elusive to clinicians and scientists. Local and systemic aberrations in immune response are associated with endometriosis. This article reviews the literature regarding various immunological factors such as cytokines, growth factors, adhesion molecules and angiogenic factors involved in the etiopathogenesis of this disease. Our review summarizes the literature regarding biomarkers, which may be reliable nonsurgical tools used in the diagnosis of endometriosis. Superior biomarkers characterized by high sensitivity, specificity and predictive value can help in the early detection and monitoring of disease progression as well as its response to therapeutic treatments critical for its management. A combination predictive model utilizing multiple biomarkers rather then individual markers alone is proposed to improve the diagnostic performance for identifying women with a high likelihood of having endometriosis. Immunomodulators and angiogenic factor blockers have a potential for endometriosis treatment and also to alleviate the pain or infertility associated with the disease. Potential new therapeutic agents include modulators, such as cytokine receptor blockers and angiogenic receptor blockers, presently used for treating endometriosis.     

子宫内膜异位症与白细胞介素16关系的研究进展

子宫内膜异位症是一种女性常见妇科疾病,组织学特征是子宫内膜组织移位到子宫外,包括盆腔腹膜、卵巢和肠等。痛经、慢性盆腔痛、月经异常和不孕是其主要症状,导致的个体和全球社会经济负担十分显著。腹腔镜检查仍然是诊断病情的金标准。然而,手术的侵入性,加上缺乏实验室生物标志物,导致从症状发作到明确诊断的平均潜伏期为7～11年。而且,诊断的延迟可能会对疾病进展产生重大影响。对子宫内膜异位症的非手术检测,发现敏感度和特异度均较高的生物标志物有助于早期诊断和预防有害后遗症,并且是一个明确的研究重点。目前子宫内膜异位症发病机制不明,免疫因素及炎症反应被报道在发病中起着重要作用。其中,白细胞介素16（IL-16）在子宫内膜异位症发病机制中的作用日益受到重视。IL-16是一种趋化因子和T细胞激活的调节剂,由CD4介导其信号转导过程。综述IL-16的表达与子宫内膜异位症发病的关系。     

The role of adhesive molecules in pathogenesis of endometriosis. Laboratory findings and clinical aspects

Adhesive molecules have played an important and well-established role in cell-to-cell communication for a long time. They reveal specific functions in an ongoing disturbed immunological reactions, including endometriosis. This review is to describe the role of topical factors involved in the pathogenesis of arising and course of endometriosis, taking adhesive molecules into special consideration. It does not only include the mechanisms and the effects of their action but also some advantages that can be gained from the knowledge of their function. The attention is also drawn to the putative role of certain proteolitical enzymes and their inhibitors which when more active can intensify or reduce the symptoms of the disease.     

High prevalence of autoimmune diseases in women with endometriosis: a case-control study

Abstract

The immune system seems to be involved in the pathogenesis of endometriosis. Peritoneal chronic inflammation is present and natural killer cells and macrophages abnormalities have been reported in women with the disease. Moreover, a higher production of serum autoantibodies has been found, which could be related to various factors; some still need to be clarified. The correlation between endometriosis and autoimmune diseases is still unclear with few and conflicting available data. The aim of this study was to evaluate the prevalence of autoimmune diseases, as conditions with a possible common pathogenetic factor, in women affected by endometriosis, in order to address future research on its pathogenesis. This retrospective case-control study includes one hundred and forty-eight women with endometriosis and 150 controls. All women were aged between 18 and 45. Informed consent was obtained from all participants of the study. Considered autoimmune diseases include systemic lupus erythematosus (SLE), celiac disease (CD), inflammatory bowel disease (IBD), and autoimmune thyroiditis. Statistical comparison of patients and control group was performed by means of chi-square test or Fisher’s exact test as appropriate. Statistical comparison of parametric variable (age) among the groups was performed by t-test for unpaired data. Age was expressed as mean. A value of .05 or less was considered as significant. In the case group, five patients were affected by IBD, while the disease was not observed in the control group (p?=?.07). SLE was found in eight patients in the case group, while only one was found in the control group (p?=?.01). Fifteen women in the case group were affected by CD, while the disease was present only in one woman in the control group (p<.0001). A significant correlation was also found between endometriosis and autoimmune thyroiditis: 80 patients with endometriosis had thyroid diseases versus 14 patients in the control group (p<.0001). Our study reports an association between endometriosis and autoimmune disorders, showing a higher prevalence of autoimmune diseases in women affected by endometriosis. These results support a possible autoimmune pathogenesis of endometriosis.     

Should Genetics Now Be Considered the Pre-eminent Etiologic Factor in Endometriosis?

Endometriosis is a common, estrogen-dependent, inflammatory disorder characterized by the growth of endometrial-like tissue at extrauterine locations. Its pathogenesis and mechanisms underlying its pathophysiology are poorly understood, although genetic variation is strongly implicated in these processes. Genetic studies reveal that approximately 50% of risk for endometriosis is due to genetic factors and the other 50% likely owing to environmental factors. As with other complex diseases, genetic variants in the DNA sequence increasing endometriosis risk all have small effects, unlike most single-gene disorders. It is the combinations of these variants adding together that contribute to higher risks for individual women. In addition, recent data on disease lesions demonstrate a high frequency of somatic (likely acquired) mutations, some of which are present in the eutopic endometrium and specifically in the epithelial cell compartment, raising the possibility that abnormal epithelial progenitors in the eutopic endometrium give rise to ectopic disease. Discovery in this field is occurring at a rapid pace, and further definitions of genetic (germline) and environmental (somatic) contributions to the pathogenesis and pathophysiology of this disorder are anticipated soon. These discoveries are expected to increase diagnostic, therapeutic, and preventive strategies to minimize disease and its associated morbidities.     

Conservative treatment of endometriosis

The patients with endometriosis have shown a significant increase in frequency in our country. In the recent years, the incidence of endometriosis in gynecological outpatients is probably 3%. In infertile patients, endometriosis has been demonstrated by laparoscopy in 20-30% of cases. The pregnancy rate of women with endometriosis has been noted to be 80-85% in the internal endometriosis and 50-60% in the external endometriosis. The risk of infertility is greater in women with external endometriosis than in women with internal endometriosis. The causes of infertility are multiple and additive. Mechanical interference with the reproductive function plays a predominant role. Pelvic adhesions involving ovaries and fallopian tubes interfere mechanically with ovulation, ovum pick-up and ovum transport. According to Brosens et al. the frequency of LUF syndrome is in excess of 79% in the patients with endometriosis. Another antifertility effect of endometriosis may involve coital avoidance due to dyspareunia, hyperprolactinemia, increased phagocytosis of spermatozoa and altered prostaglandin secretion in peritoneal fluid. Conservative treatment of endometriosis is associated with improvement infertility and the post-treatment pregnancy rate has become an acceptable indicator of the effectiveness of therapy. The choice of therapeutic approach depends on several factors including age of the patient, extent of the disease, extent and location of pelvic adhesions and other coexisting infertility factors. Several hormonal regimens have been recommended for the treatment of endometriosis. They include androgen, progestogens and pseudopregnancy, danazol-induced pseudomenopause, gestrinone and LH-RH agonists.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effect of endometriosis on in vitro fertilization outcome

AIM: Endometriosis is a leading cause of pelvic pain and infertility. Implantation of endometrial cells to the peritoneal surface can lead to a spectrum of disease severity with the most severe causing extensive pelvic adhesions and anatomic distortion. Infertility can result from anatomic abnormalities as well proinflammatory cellular and immune factors. Treatment options for women seeking pregnancy include surgical removal and/or in vitro fertilization. The aim of this study was to review current literature on the pathogenesis of endometriosis and treatment options for infertility. METHODS: Recent published articles regarding infertility and endometriosis have been reviewed analyzing PubMed and Cochrane databases. RESULTS: In vitro fertilization (IVF) is a valid option for patients after surgical management has not restored fertility. IVF may be offered sooner to older patients or to those with more severe disease. It is unclear if prior surgical treatment has deleterious effects on IVF outcomes. It does appear, however, that surgical removal of endometriomas may lead to decreased ovarian reserve. This may not affect fertility outcomes. CONCLUSION: Endometriosis is a leading cause of pelvic pain and infertility. The most accepted theory of how endometriosis develops is the retrograde transplant theory by Sampson, but a constellation of numerous other factors are involved. The gold standard for diagnosis is operative; therefore, the true prevalence of this disease is uncertain. Many women with endometriosis will seek fertility treatment. In this case if endometriosis is found, it should be treated.     

Peritoneal fluid environment in endometriosis. Clinicopathological implications

Endometriosis is a puzzling disorder with obscure pathogenesis. The objective of this review was to evaluate the complex role of peritoneal fluid in the etiopathogenesis of endometriosis. Several studies suggest that peritoneal fluid is a key inflammatory environment associated with endometriosis. Many active substances (cytokines, growth factors, hormones and oxidative stress parameters) have been identified in endometriosis patients at different stages of the disease. Inflammatory mediators may be involved in the endometriosis associated-infertility and possibly pain. Furthermore, these mediators may represent a non surgical method for diagnosing endometriosis. Better understanding of the mechanism of cytokines, growth factor and reactive oxygen species production and detoxification and further investigation of their effects on the peritoneal fluid environment are essential to obtain new insight into this disease and eventually develop novel diagnostic and therapeutic remedies.