Pain, mast cells, and nerves in peritoneal, ovarian, and deep infiltrating endometriosis
Pain, mast cells, and nerves in peritoneal, ovarian, and deep infiltrating endometriosis
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DOI：
10.1016/j.fertnstert.2006.03.057
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发表时间：
2006-11-01
影响因子：
6.7
通讯作者：
Noel, Jean-Christophe
中科院分区：
文献类型：
--
作者：
Anaf, Vincent;Chapron, Charles;Noel, Jean-Christophe
目的：检测和定量腹膜、卵巢及深浸润性子宫内膜异位症中肥大细胞的数量，探讨肥大细胞与神经的关系。设计：前瞻性组织学和免疫组织化学研究。单位：比利时布鲁塞尔大学。患者：69名因疼痛接受腹腔镜子宫内膜异位症切除术的妇女。37例正常组织活检来自无子宫内膜异位症的妇女。干预：从不同解剖位置切除子宫内膜。主要观察指标：免疫组化与乳糜酶和胰蛋白酶分别确认子宫内膜异位症病变中肥大细胞和活化肥大细胞的存在。子宫内膜异位症不同部位肥大细胞、活化肥大细胞和脱颗粒肥大细胞的定量分析。利用S-100蛋白免疫组织化学染色，对神经25 μ m以内的肥大细胞进行定量分析，研究肥大细胞与神经的关系。术前疼痛评分视觉模拟量表评估。结果：深浸润性病变患者术前疼痛评分明显高于腹膜或卵巢子宫内膜异位症患者。肥大细胞和脱颗粒肥大细胞在子宫内膜异位症病变中明显比在未受影响的组织中丰富。与腹膜和卵巢病变相比，深度浸润性病变中肥大细胞、活化肥大细胞和距离神经< 25 μ m的肥大细胞数量明显增加。我们发现深度浸润性病变中脱颗粒肥大细胞明显多于腹膜性病变。结论：在深度浸润性子宫内膜异位症中，激活肥大细胞和脱颗粒肥大细胞的增加是最痛苦的病变，肥大细胞与神经之间的密切组织学关系强烈提示肥大细胞可能通过直接影响神经结构而参与子宫内膜异位症疼痛和痛觉过敏的发展。
Objective: To detect and quantify mast cells in peritoneal, ovarian, and deep infiltrating endometriosis and to study the relationship between mast cells and nerves in endometriosis.Design: Prospective histological and immunohistochemical study.Setting: University of Brussels, Belgium.Patient(s): Sixty-nine women undergoing laparoscopic excision of endometriosis for pain. Thirty-seven biopsies of normal tissue were obtained from women without endometriosis.Intervention(s): Excision of endometrics from different anatomical locations.Main Outcome Measure(s): Immunohistochemical with chymase and tryptase to confirm the presence of mast cells and activated mast cells, respectively, in endometriotic lesions. Quantification of mast cells, activated mast cells, and degranulating mast cells in the different locations of endometriosis. Study of the relationship between mast cells and nerves by quantifying mast cells located less than 25 mu m from nerves immunohistochemically stained with S-100 protein. Preoperative pain score evaluation by visual analogue scales.Result(s): Patients with deeply infiltrating lesions had significantly higher preoperative pain scores than patients with peritoneal or ovarian endometriosis. MAst cells and degranulating mast cells are significantly more abundant in endometriotic lesions than in nonaffected tissues. Deep infiltrating lesions show a significantly higher number of mast cells, activated mast cells , and mast cells located < 25 mu m from nerves than peritoneal and ovarian lesions. We found significantly more degranulating mast cells in deep infiltrating lesions than in peritoneal lesions.Conclusin(s): The presence of increased activated and degranulating mast cells in deeeply infiltrating endometrisis, which are the most painful lesins, and the close histological relationship between mast cells and nerves strongly suggest that mast cells couldcontribute to the development of pain and hyperalgesia in endometriosis, possible by a direct effect on nerve structures.