Endometriosis-induced vaginal hyperalgesia in the rat: role of the ectopic growths and their innervation.
Endometriosis-induced vaginal hyperalgesia in the rat: role of the ectopic growths and their innervation.
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DOI：
10.1016/j.pain.2009.09.022
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发表时间：
2009-12-15
期刊：
影响因子：
7.4
通讯作者：
Berkley KJ
中科院分区：
文献类型：
--
作者：
McAllister SL;McGinty KA;Resuehr D;Berkley KJ
子宫内膜异位症是一种疼痛性疾病，其定义为子宫外子宫内膜生长，其对疼痛症状的作用知之甚少。子宫内膜异位症是通过将子宫（ENDO）或脂肪（shamENDO）自体移植到腹部动脉上而产生的，其中子宫（ENDO）形成囊肿，脂肪（shamENDO）不形成囊肿。ENDO，而不是shamENDO诱导阴道痛觉过敏。我们通过评估手术切除囊肿的效果来验证囊肿是维持阴道痛觉过敏所必需的假设。完全囊肿切除消除了ENDO诱导的阴道痛觉过敏，术后4个月。在ENDO大鼠中，假囊肿去除，其中囊肿未被去除，或部分囊肿去除增加了ENDO诱导的痛觉过敏。下降和增加都需要三到六周的时间来发展。ENDO诱导的痛觉过敏的变化没有发生在对照组的ENDO大鼠中，这些大鼠在ENDO后没有手术。在双手术对照组中，无论是shamENDO手术还是随后的假手术，模拟“去除”不存在的囊肿，都不会影响阴道伤害性感受。在非手术对照组中，阴道伤害感受保持稳定> 6个月。假囊肿切除手术产生的ENDO诱导的痛觉过敏的增加在发情前期比在其他发情阶段小。在其他阶段（但不是在发情前期），交感神经支配的囊肿增加。这些结果表明，维持ENDO诱导的阴道痛觉过敏需要至少一些异位子宫内膜组织的持续存在，并且未能去除异位子宫内膜组织的手术治疗可能会加剧痛觉过敏，这可能部分是由于囊肿交感神经支配的增加。
Endometriosis is a painful disorder defined by extrauteral endometrial growths whose contribution to pain symptoms is poorly understood. Endometriosis is created in rats by autotransplanting on abdominal arteries pieces of either uterus (ENDO), which form cysts, or fat (shamENDO), which do not form cysts. ENDO, but not shamENDO induces vaginal hyperalgesia. We tested the hypothesis that the cysts are necessary to maintain vaginal hyperalgesia by assessing the effect of surgically removing them. Complete cyst removal eliminated ENDO-induced vaginal hyperalgesia up to four months post-operatively. Sham-cyst-removal in ENDO rats, in which cysts were not removed, or partial cyst-removal increased the ENDO-induced hyperalgesia. The decreases and increases both took three to six weeks to develop. Changes in ENDO-induced hyperalgesia did not occur in a control group of ENDO rats who had no surgery after ENDO. In a double-surgery control group, neither shamENDO surgery nor a subsequent sham surgery that mimicked “removal” of non-existent cysts influenced vaginal nociception. In a no-surgery control group, vaginal nociception remained stable for > six months. The increases in ENDO-induced hyperalgesia produced by the sham-cyst-removal surgery were smaller in proestrus than in other estrous stages. During the other stages (but not during proestrus), sympathetic innervation of the cysts increased. These results suggest that maintenance of ENDO-induced vaginal hyperalgesia requires continued presence of at least some ectopic endometrial tissue, and that surgical treatment that fails to remove ectopic endometrial tissue can exacerbate the hyperalgesia, possibly due in part to an increase in the cysts’ sympathetic innervation.
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