低氧对子宫内膜异位症影响的研究进展

子宫内膜异位症（EMs）是育龄期女性最常见的妇科疾病之一,是具有恶性行为的良性疾病,可发生于全身各个部位。导致EMs的危险因素众多,主要包括内分泌、遗传、环境和免疫因素。目前EMs的病因仍然未知,近年来有研究表明缺氧是EMs发生的驱动力,缺氧可以通过3个方面影响EMs的发生和发展,一是缺氧过度激活环氧合酶2/前列腺素E₂（COX-2/PGE₂）而上调类固醇激素生成酶,因此促进雌激素生成,同时缺氧降低雌激素受体α（ERα）与ERβ的比值和孕激素受体（PR）,改变类固醇激素的作用效率;二是缺氧激活血管内皮生长因子（VEGF）、血管生成素（Ang）等血管生成因子促进异位病灶快速形成血管,为异位病灶生长提供氧气及营养物质;三是缺氧干扰EMs细胞的正常自噬过程,促进其发生侵袭、转移。综述缺氧参与EMs的发病机制以及相关治疗,以期为临床诊断、治疗提供新视角。

Research Progress on the Effect of Hypoxia on Endometriosis

Endometriosis (EMs) is one of the most common gynecological diseases in women of childbearing age. It is a benign disease with malignant behavior and can occur in various parts of the body. There are many risk factors leading to EMs, including endocrine, genetic, environmental and immune factors. At present, the etiology of EMs is still unknown. Recent studies have shown that hypoxia is the driving force of EMs. Hypoxia can affect the occurrence and development of EMs in three aspects. (1) Hypoxia over-activates COX-2/PGE₂ and up-regulates steroid hormone-producing enzymes, thus promoting estrogen production; at the same time, hypoxia reduces the ratio of ERα to ERβ and PR, and changes the efficiency of steroids. (2) Hypoxia-activated angiogenic factors such as VEGF and Ang promote the rapid formation of blood vessels in ectopic lesions and provide oxygen and nutrients for the growth of ectopic lesions. (3) Hypoxia interferes with the normal autophagy process of EMs cells and promotes its invasion and metastasis. This paper reviews the pathogenesis and related treatment of hypoxia in EMs, in order to provide a new perspective for clinical diagnosis and treatment.