The Neural Immune Mechanisms and Genetic Influences on C

C的神经免疫机制和遗传影响

• 批准号: 7334140
• 负责人: pamela stratton
• 金额: --
• 依托单位: EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7334140
• 关键词: Neural; Immune; Mechanisms; Genetic; Influences

Chronic pelvic pain accounts for 10 percent of all gynecology visits; most women with chronic pelvic pain have endometriosis, a condition in which endometrial glands and stroma grow on pelvic surfaces outside the uterus. We evaluated adhesion reformation following laparoscopic excision of endometriosis and adhesiolysis in women with chronic pelvic pain in 38 women who had two surgeries as part of this study. Adhesions formed or reformed if they were thicker, in areas of prior adhesions, or if they involved the ovary. Most patients developed adhesions after radical surgical excision of endometriosis for pelvic pain. The high incidence of adhesion formation following surgery for endometriosis underscores the importance of optimizing surgical techniques to potentially reduce adhesion formation. We considered the prevalence of appendiceal disease in women with chronic pelvic pain undergoing laparoscopy for possible endometriosis and summarized the literature, to more accurately estimate the prevalence of endometriosis. We found that appendiceal endometriosis, while relatively uncommon in patients with endometriosis (4.1% in our series and 2.8% in a literature review), is rare in the general population (0.4%) suggesting the appendix should be inspected for endometriosis and evidence of non-gynecologic disease in patients with right lower quadrant or pelvic pain. To better understand endometriosis, chronic pelvic pain and its treatment, we have analyzed a survey of Endometriosis Association members reporting surgical diagnosed endometriosis. Of 1,160 women, 95% of respondents reported pelvic pain, had endured symptoms on average of 16 years, and were young (mean: 36 years), white, and educated. Many women (46%) had tried 3+ medical treatments, and almost 20% took them for 10+ years. Surgical procedures were performed at least 3 times on 42%. Nearly 20% had a hysterectomy or oophorectomy; these procedures were reported as most successful in improving symptoms. Despite reporting various treatments as helpful, women used many different types and endured symptoms for an average of almost two decades, indicating the profound effect of endometriosis on women?s health. We have also considered the relationship between disease severity and patient characteristics in endometriosis by analyzing questionnaires from 1,000 women in the Oxford Endometriosis Gene (OXEGENE) Study. Women were assigned to Group I (rAFS Stage I-II, n=423) or Group II (rAFS Stages III-IV, n=517). Women in Group I were significantly younger on entering the study at symptom onset, seeking medical attention, and diagnosis but the overall time to diagnosis did not differ between groups. The most common symptoms leading to a diagnosis were dysmenorrhea and pelvic pain. Dyspareunia and depression were more common in Group I. In Group II, sub-fertility and an ovarian mass more commonly led to a diagnosis. Sub-fertility remained more common in Group II throughout reproductive life, but birth and miscarriage rates were similar. This study shows differences in characteristics of women with different stages of endometriosis, which may aid future clinical and epidemiological studies. Remarkably, the time to diagnosis was similar between women with different stages of disease.

慢性盆腔疼痛占所有妇科就诊的10%;大多数患有慢性盆腔疼痛的女性患有子宫内膜异位症，子宫内膜腺体和基质生长在子宫外的盆腔表面。我们评估了38名接受两次手术的慢性盆腔疼痛妇女在腹腔镜子宫内膜异位症切除术和粘连松解术后的粘连重建情况。如果粘连较厚，在先前粘连的区域，或者如果它们涉及卵巢，则粘连形成或重新形成。大多数患者因盆腔疼痛行子宫内膜异位症根治性手术切除后发生粘连。子宫内膜异位症手术后粘连形成的高发生率强调了优化手术技术以减少粘连形成的重要性。 我们考虑了因慢性盆腔疼痛行腹腔镜检查可能的子宫内膜异位症的女性中阑尾疾病的患病率，并总结了文献，以更准确地估计子宫内膜异位症的患病率。我们发现阑尾子宫内膜异位症在子宫内膜异位症患者中相对少见（在我们的系列中为4.1%，在文献综述中为2.8%），但在一般人群中罕见（0.4%），这表明在右下腹或盆腔疼痛患者中应检查阑尾是否存在子宫内膜异位症和非妇科疾病的证据。 为了更好地了解子宫内膜异位症，慢性盆腔疼痛及其治疗，我们分析了子宫内膜异位症协会成员报告手术诊断子宫内膜异位症的调查。在1,160名女性中，95%的受访者报告盆腔疼痛，平均症状持续时间为16年，并且是年轻（平均年龄：36岁），白色，受过教育。许多女性（46%）曾尝试过3种以上的药物治疗，近20%的人接受了10年以上的治疗。42%的患者至少进行了3次手术。近20%的患者进行了子宫切除术或卵巢切除术;据报道，这些手术在改善症状方面最为成功。尽管报告了各种治疗方法的帮助，但妇女使用了许多不同的类型，并平均忍受了近二十年的症状，这表明子宫内膜异位症对妇女的深远影响？的健康。 我们还通过分析牛津子宫内膜异位症基因（OXEGENE）研究中1,000名妇女的问卷调查，考虑了疾病严重程度与子宫内膜异位症患者特征之间的关系。女性被分配到第I组（rAFS I-II期，n = 423）或第II组（rAFS III-IV期，n = 517）。第一组的女性在症状发作、就医和诊断时进入研究时明显更年轻，但两组之间的总体诊断时间没有差异。导致诊断的最常见症状是痛经和骨盆疼痛。性交困难和抑郁症在I组中更常见。在第二组中，低生育力和卵巢肿块更常导致诊断。在整个生育期内，第二组的低生育率仍然更常见，但出生率和流产率相似。这项研究显示了不同阶段子宫内膜异位症妇女的特征差异，这可能有助于未来的临床和流行病学研究。值得注意的是，不同疾病阶段的女性之间的诊断时间相似。