Nerve Bundles and Deep Dyspareunia in Endometriosis
Nerve Bundles and Deep Dyspareunia in Endometriosis
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DOI：
10.1177/1933719115623644
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发表时间：
2016-07-01
影响因子：
2.9
通讯作者：
Yong, Paul J.
中科院分区：
文献类型：
--
作者：
Williams, Christina;Hoang, Lien;Yong, Paul J.
子宫内膜异位症深性交困难的病因尚不清楚。我们的目的是确定子宫囊尾/子宫骶（II区）的神经束密度是否与子宫内膜异位症女性的深度性交困难有关。我们在一家三级转诊中心（2011-2013）进行了一项盲法回顾性免疫组织化学研究（n = 58）。将患者严格分型为研究组和2个对照组。研究组（压痛性子宫内膜异位症，n = 29）包括深性交困难患者，检查时压痛II区，手术切除II区子宫内膜异位症病变。对照组1（非压痛性子宫内膜异位症，n = 17）包括无深度性交困难的患者，检查为非压痛性II区，II区切除子宫内膜异位症病变。对照组2（压痛性非子宫内膜异位症，n = 12）包括深度性交困难患者，检查时压痛II区，II区手术切除的非子宫内膜异位症病变（如组织学正常）。采用蛋白基因产物9.5 （PGP9.5）免疫组化方法鉴定切除II区病变中的神经束（神经束周围的神经纤维）。然后由病理学家对组进行PGP9.5神经束密度（束/高功率场[HPF]）评分。我们发现三组患者PGP9.5神经束密度差异有统计学意义（方差分析，F-2,F-55 = 6.39, P = 0.003）。研究组PGP9.5神经束平均密度（1.16 +/- 0.56束/HPF[+/-标准差]）显著高于对照组1（0.65 +/- 0.36束/HPF， Tukey检验，P = 0.005）和对照组2（0.72 +/- 0.56束，Tukey检验，P = 0.044）。本研究提供了证据，表明子宫囊尾/子宫骶神经发生可能是子宫内膜异位症中深度性交困难的一个病因。
The etiology of deep dyspareunia in endometriosis is unclear. Our objective was to determine whether nerve bundle density in the cul-de-sac/uterosacrals (zone II) is associated with deep dyspareunia in women with endometriosis. We conducted a blinded retrospective immunohistochemistry study (n = 58) at a tertiary referral center (2011-2013). Patients were stringently phenotyped into a study group and 2 control groups. The study group (tender endometriosis, n = 29) consisted of patients with deep dyspareunia, a tender zone II on examination, and an endometriosis lesion in zone II excised at surgery. Control group 1 (nontender endometriosis, n = 17) consisted of patients without deep dyspareunia, a nontender zone II on examination, and an endometriosis lesion in zone II excised at surgery. Control group 2 (tender nonendometriosis, n = 12) consisted of patients with deep dyspareunia, a tender zone II on examination, and a nonendometriosis lesion (eg, normal histology) in zone II excised at surgery. Protein gene product 9.5 (PGP9.5) immunohistochemistry was performed to identify nerve bundles (nerve fibers surrounded by perineurium) in the excised zone II lesion. PGP9.5 nerve bundle density (bundles/high powered field [HPF]) was then scored by a pathologist blinded to the group. We found a significant difference in PGP9.5 nerve bundle density between the 3 groups (analysis of variance, F-2,F-55 = 6.39, P = .003). Mean PGP9.5 nerve bundle density was significantly higher in the study group (1.16 +/- 0.56 bundles/HPF [+/- standard deviation]) compared to control group 1 (0.65 +/- 0.36, Tukey test, P = .005) and control group 2 (0.72 +/- 0.56, Tukey test, P = .044). This study provides evidence that neurogenesis in the cul-de-sac/uterosacrals may be an etiological factor for deep dyspareunia in endometriosis.