The Neural Immune Mechanisms and Genetic Influences on Chronic Pelvic Pain

慢性盆腔疼痛的神经免疫机制和遗传影响

• 批准号: 7594231
• 负责人: pamela stratton
• 金额: $ 140.46万
• 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/7594231
• 关键词: Accounting; Adolescence; Adolescent; Anxiety; Characteristics; Chronic stress; Clinical; Condition; Consult; Corticotropin; Diagnosis; Diagnostic; Disease; Dysmenorrhea; Dyspareunia; Endometrial; Epidemiologic Studies; Fertility; Fibromyalgia; Future; General Practitioners; Genes; Genetic; Gland; Goals; Gynecologist; Gynecology; HPSE gene; Hormones; Hydrocortisone; Immune; Immunologic Deficiency Syndromes; Immunologics; Injection of therapeutic agent; Live Birth; Medical; Mental Depression; Morbidity - disease rate; Operative Surgical Procedures; Ovarian Mass; Pain; Patients; Pattern; Pelvic Pain; Pelvis; Physicians; Process; Questionnaires; Rate; Relative (related person); Reporting; Respondent; Risk; Score; Severity of illness; Spontaneous abortion; Staging; Surface; Surveys; Symptoms; Time; Uterus; Visit; Woman; Women' s Health; chronic pain; chronic pelvic pain; endometriosis; experience; girls; hypothalamic-pituitary-adrenal axis; member; relating to nervous system; reproductive; response

Peak ACTH levels were significantly higher among those with chronic pain alone, or those with pain and endometriosis than normal controls. ACTH response curves differed from controls in women with pain, significantly differing with higher levels at 30 and 45 minutes. Cortisol response curves were similar for both groups. Of 18 women with chronic pelvic pain, 10 had a normal and 8 had an altered ACTH response. Mean depression and anxiety scores did not differ between normal and abnormal responders with chronic pelvic pain. Women with chronic pelvic pain and endometriosis, and to a lesser degree those with chronic pelvic pain alone, experience heightened ACTH secretion without corresponding changes in cortisol levels in response to Corticorelin Injection, similar to the pattern observed with fibromyalgia and chronic stress. This atypical ACTH response may indicate a relative immunodeficiency and could account for some of the immunologic changes and co-morbidities observed in these women. To better understand endometriosis, chronic pelvic pain and its treatment, we have analyzed a survey of 4,334 Endometriosis Association members reporting surgically diagnosed endometriosis. We have investigated whether the first doctor seen and adolescent onset of symptoms impact the diagnostic process of endometriosis. Almost all respondents reported pelvic pain with 50% first consulting a gynecologist and 45% a generalist for symptoms of endometriosis. Women and girls who reported seeing a gynecologist first for symptoms of endometriosis were more likely to have a shorter time to diagnosis, see fewer physicians, and report a better experience overall with their physicians. The majority reported onset of symptoms during adolescence, who reported a longer time and a worse experience while obtaining a diagnosis. 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). 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.

单独患有慢性疼痛或患有疼痛和子宫内膜异位症的患者的ACTH峰值水平明显高于正常对照组。疼痛女性的ACTH反应曲线与对照组不同，在30分钟和45分钟时水平较高时差异显著。两组的皮质醇反应曲线相似。在18名患有慢性盆腔疼痛的女性中，10名ACTH反应正常，8名ACTH反应改变。慢性盆腔疼痛的平均抑郁和焦虑评分在正常应答者和异常应答者之间没有差异。患有慢性盆腔疼痛和子宫内膜异位症的妇女，以及在较小程度上仅患有慢性盆腔疼痛的妇女，在皮质激素注射后，ACTH分泌增加，而皮质醇水平没有相应的变化，这与纤维肌痛和慢性应激观察到的模式相似。这种非典型ACTH反应可能表明相对免疫缺陷，并可能解释在这些妇女中观察到的一些免疫变化和合并症。