神经纤维束状浸润与深部浸润型子宫内膜异位症疼痛相关性研究  

Nerve fiber bundle invasion in deep infiltrating endometriosis and its relationship with the severity of pain

作　　者：梁炎春[1] 陈玉清[1] 刘多[1] 刘田雨[1] 尚春亮 郭鲁燕[1] 吴锦杰[2] 谢鸿玉 姚书忠[1] 

机构地区：[1]中山大学附属第一医院妇产科,广东广州510080 [2]中山大学中山医学院,广东广州510080

出　　处：《中国实用妇科与产科杂志》2016年第9期877-881,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：中山大学2015年第二批学生业余科研项目(59);广州市科技计划项目(201300000169);广东省科技计划项目(2013B021800237)

摘　　要：目的探讨深部浸润型子宫内膜异位症(DIE)宫骶韧带病灶及阴道直肠隔病灶中神经纤维束状浸润(NFBI)情况及其与患者疼痛的相关性。方法收集2012-06-01—2015-01-01在中山大学附属第一医院妇科行手术治疗的64例DIE患者,采用免疫组化的方法分别检测宫骶韧带病灶和阴道直肠隔病灶中神经纤维蛋白基因产物9.5(PGP9.5)和GAP-43染色阳性的神经纤维。根据是否存在神经纤维束状浸润分为两组:NFBI阳性组和NFBI阴性组。比较两组患者痛经、肛门坠胀痛、性交痛和慢性盆腔痛程度,并探讨二者之间新生神经纤维密度的差异。结果宫骶韧带DIE病灶中NFBI阳性组痛经、肛门坠胀痛和慢性盆腔痛评分均比NFBI阴性组高,差异有统计学意义(均P<0.05);性交痛评分两组差异无统计学意义(P=0.12)。阴道直肠隔DIE病灶中NFBI阳性组痛经、肛门坠胀痛、性交痛和慢性盆腔痛评分均比NFBI阴性组高,差异均有统计学意义(均P<0.05)。宫骶韧带DIE病灶和阴道直肠隔DIE病灶中NFBI阳性患者的新生神经纤维(GAP-43染色阳性的神经)密度均比NFBI阴性患者高,差异均有统计学意义(P=0.001,P=0.007)。结论深部浸润型子宫内膜异位症病灶中神经纤维束状浸润与患者疼痛的严重程度相关,其原因之一可能是刺激新生神经纤维生长增加。Objective To study nerve fiber bundle invasion （NFB1） in deep infiltrating endometriosis （DIE） and explore its relationship with the severity of pain. Methods Samples were collected from 64 women undergoing surgery for DIE in Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University （from June 1, 2012 to January 1, 2015）.Immunohistochemistry was used to detect PGP 9.5 and GAP-43 positive stained nerve fibers in uterosacral ligament DIE （USL-DIE） and rectovaginal septum DIE （RVS-DIE）.Patients were divided into NFBI （＋） group and NFBI （-） group.The severity of pain （including dysmenurrhea, tenesmus, dyspareunia and chronic pelvic pain） and the newly grown nerve fiber density were compared between these two groups. Results The VAS scores of dysmenorrhea, tenesmus and chronic pelvic pain in patients with USL-DIE were significantly higher in NFBI （＋） group than NFBI （-） group （all of the P values were less than O.05）.But the difference of VAS score of dyspareunia between these two groups was not statistically significant （P=0.12）.The VAS scores of dysmenorrhea, tenesmus, dyspareunia and chronic pelvic pain in patients with RVS-DIE were significantly higher in NFBI （＋） group than in NFBI （-） group （all ofthe P values were less than 0.05）.The newly grown nerve fiber （GAP-43 positive stained） density of USL-DIE or RVS-DIE in NFBI （＋） patients was higher than that in NFBI （-） patients （P=0.001 and P=0.007, respectively）. Conclusion Nerve fiber bundle invasion in endometriotic lesion is related to the severity of pain symptoms in DIE patients, which may be due to the increased growth stimulation of newly formed nerve fibers.

关 键 词：深部浸润型子宫内膜异位症 神经纤维 神经纤维蛋白基因产物9.5 疼痛 免疫组织化学 

分 类 号：R711.71[医药卫生—妇产科学]