摘要目的 探讨子宫腺肌病(腺肌病)患者子宫内膜神经纤维分布与腺肌病发病以及痛经的关系.方法 选择经手术切除子宫的患者74例,其中腺肌病组32例(包括有痛经22例,无痛经10例),子宫肌瘤(肌瘤)组42例(包括有痛经15例,无痛经27例).应用免疫组化Envision二步法检测子宫内膜神经纤维的分布,分别用抗神经微丝蛋白(NF)抗体与抗蛋白基因产物9.5(PGP9.5)抗体检测有髓与无髓神经纤维.结果 腺肌病和肌瘤组有痛经者的子宫内膜功能层PGP9.5免疫反应阳性神经纤维检出率分别为64%(14/22)和67%(10/15),PGP9.5免疫反应阳性神经纤维密度分别为0.6(0～9.4)和0.6(0～6.0)条/mm2;两组分别比较,差异均无统计学意义(P均＞0.05);两组均无NF免疫反应阳性神经纤维检出.腺肌病和肌瘤组无痛经者的子宫内膜功能层均无神经纤维检出.腺肌病组痛经者与无痛经者的子宫内膜基底层PGP9.5免疫反应阳性神经纤维检出率和神经纤维密度分别为64%(14/22)和1.1(0～12.0)条/mm2、50%(5/10)和0.6(0～3.0)条/mm2;NF免疫反应阳性神经纤维检出率和神经纤维密度分别为23%(5/22)和0(0～0.6)条/mm2、20%(2/10)和0(0～1.0)条/mm2.肌瘤组痛经者与无痛经者的子宫内膜基底层PGP9.5免疫反应阳性神经纤维检出率和神经纤维密度分别为80%(12/15)和1.6(0～10.0)条/mm2、44%(12/27)和0(0～5.0)条/mm2;NF免疫反应阳性神经纤维检出率和神经纤维密度分别为40%(6/15)和0(0～0.4)条/mm2、15%(4/27)和0(0～1.0)条/mm2;子宫内膜基底层PGP9.5和NF免疫反应阳性神经纤维密度在腺肌病和肌瘤组痛经者间以及在无痛经者间比较,差异均无统计学意义(P均＞0.05),但两组痛经者子宫内膜基底层PGP9.5免疫反应阳性神经纤维密度均显著高于同组无痛经者(P均＜0.05).结论 子宫内膜PGP9.5免疫反应阳性神经纤维可能参与痛经的发生;NF免疫反应阳性神经纤维可能与痛经的发生无关;子宫内膜神经纤维增生可能与疾病本身无关.

abstractsObjective To investigate nerve fibers distribution in endometrium of adenomyosis and their relationship with dysmenorrhea. Methods Endometrial tissue was sampled from 74 hysterectomy specimens including 32 cases with adenomyosis and 42 cases with uterine fibroids. Two-step Envision immunohistochemical staining was used to detect distribution of nerve fibers in endometrium. Highly specific polyclonal rabbit anti-protein gene product 9.5 (PGP9.5) and monoclonal mouse anti-neurofilament protein (NF) were used to demonstrate both myelinated and unmyelinated nerve fibers in endometrium in women with adenomyosis and uterine fibroids. Results The positive rate of PGP9.5 immunoreactive nerve fibers in the functional layer of endometrium of pain patients were with 64%(14/22) in adenomyosis and 67% (10/15) in uterine fibroids. And their density were 0.6(0-9.4)/mm2 and 0.6(0-6.0)/mm2 without reaching statistical difference (P> 0.05). No expression of NF could be detected in the functional layer of endometrium of adenomyosis and uterine fibroids. There were no PGP9.5 immunoreactive nerve fibers in the functional layer of endometrium in non-pain women with adenomyosis and uterine fibroids. Moreover, No NF immunoreactive nerve fibers in the functional layer of endometrium were shown in non-pain patients with adenomyosis and uterine fibroids. PGP9.5 immunoreactive nerve fibers and the nerve density in the basal layer of endometrium were 64%(14/22), 1.1(0-12.0)/mm2 in pain adenomyosis and 50%(5/10), 0.6(0-3.0)/mm2 in non-pain adenomyosis. NF immunoreactive nerve fibers and the density in the basal layer of endometrium were 23%(5/22),(0-0.6)/mm2 in pain adenomyosis and 20% (2/10),(0-1.0)/mm2 in non-pain adenomyosis. PGP9.5 immunoreactive nerve non-pain fibroids. NF immunoreactive nerve fibers and the nerve density in the basal layer of endometrium were 40%(6/15),0(0-0.4)/mm2 in pain fibroids and 15%(4/27),0(0-1.0)/mm2 in non-pain fibroids. There was no statistical different PGP9.5 and NF immunoreactive nerve fibers distribution in basal layer of endometrium between pain adenomyosis and pain fibroids or between non-pain adenomyosis and non-pain fibroids (all P>0.05). However, PGP9.5 immunoreactive nerve fibers density in basal layer of endometrium was higher in pain adenomyosis and fibroids when compared with non-pain adenomyosis and fibroids(P<0.05). Conclusions PGP9.5 immunoreactive nerve fibers might confer the occurrence of pelvic pain, however, NF immunoreactive nerve fibers may not involved in the pathogenesis of pain.