【作者】 刘莉；

【导师】 朱新群；

【作者基本信息】 郑州大学 ， 妇产科学， 2012， 硕士

【摘要】 研究背景：子宫内膜内异症是一种严重影响育龄期妇女健康和生活质量的妇科多发病和常见病。其确切发病机制至今尚未完全阐明,在众多病因学说中,Sampson提出的经血逆流种植学说虽被多数学者接受,但此学说不能解释子宫内膜异位在盆腔外,也无法解释虽然多数(70%-90%)女性存在经血逆流现象,但只有少数(10%-15%)的妇女发病,说明它很有可能只是该病发病的诱因。近年来,随着分子生物学及免疫学技术的发展,越来越多的证据证明免疫调节异常在EM的发生、发展各环节起着至关重要的作用的,甚至很可能是决定性作用。肿瘤坏死因子α(TNF-α):可诱导腹膜细胞表达一系列黏附分子,从而使腹膜细胞与子宫内膜细胞黏附作用增强,这是异位子宫内膜成功种植腹腔的第一步。白细胞介素一8(IL-8):IL-8与其受体结合后可改变杀伤性T淋巴细胞表面表达Fas／Fas l系统,促进细胞毒性T淋巴细胞CTL(CTL)细胞的凋亡增加,腹腔内NK细胞活性下降,从而有助于异位内膜在腹腔种植时可以逃避机体的免疫监视。可溶性细胞间粘附分子1(SICAM-1):SICAM-1的升高可以有效地阻断细胞毒性T淋巴(CTL)与靶细胞(子宫内膜细胞)结合,极大地降低了其对靶细胞的粘附、杀伤功能,也可使NK细胞活性受到封闭或削弱,减弱了NK细胞在免疫监视过程中所起的主要作用。目的拟通过酶联免疫吸附法检测子宫内膜异位症患者与正常非子宫内膜异位症者血清中IL-8.TNF-α及SICAM-1表达,研究三者的相关性,以探讨三者在子宫内膜异位症发病机制中的作用及在子宫内膜异位症临床诊断中的价值。材料与方法1.研究对象选取2010年7月至2011年7月在郑州大学第二附属医院妇科住院手术病人共69例,分子宫内膜异位症组和正常对照组,36例子宫内膜异位症患者(其中Ⅰ-Ⅱ期20例,Ⅲ一Ⅳ期16例)、33例对照组妇女。研究对象筛选标准：内异症组和对照组患者均无内分泌、免疫和代谢性等相关性疾病,平素月经均较规律,术前3个月内未用过任何激素治疗。2.研究方法：采用酶联免疫法(Elisa)测定内异症患者和对照组血清中TNF-α, IL-8, SICAM-1水平。实验结果处理运用SPSS17.0统计软件系统分析,以<0.05为差异有统计学意义。结果1.EM组血清TNF-α, IL-8, SICAM-1水平均高于对照组,差异有显著性(P<0.05),且EM组Ⅲ～Ⅳ期血清TNF-α,IL-8,SICAM-1水平高于Ⅰ～Ⅱ期,差异有显著性意义(P<0.05)。2.内异症患者血清中IL-8, SICAM-1水平均与TNF-a水平呈线性正相关,IL-8与SICAM-1水平无线性关系。3. TNF-a. IL-8和SICAM-1三种因子诊断内异症的特异性分别为48.48%、45.45%、60.61%；敏感性分别为44.44%、47.22%、69.44%。结论1. TNF-a, IL-8和SICAM-1均参与了EM的发病过程,且三者具有协同作2.血清中SICAM-1在诊断内异症时有较高的敏感性和特异性,可望成为临床诊断内异症的指标。更多还原

【Abstract】 Background and PurposeEndometriosis (EM) is a multiple and common gynecologic disease which can seriously effect the health of women. The mechanism of EM has not been completely understood. It is well known that the hypothesis of endometrium exfoliative fragments transplantation which Sampson put forward has been accepted by most scholars. But this theory can’t explain endometriosis outside the pelvic.It also can’t explain most (70%-90%)women have menses blood backward phenomenon but only a few (10%-15%) of the women have suffered from it.With the development of the molecular biology and immunology technology,more more evidence shows that immune adjustment abnormalities may play a very important role in EM.Tumor necrosis factor alpha (TNF alpha) can induce skin cells express a series of peritoneal adhesion molecules, which can cause adhesion enhancement between the peritoneum cells and endometrial cells. This is the first step of endometriosis to plant in the abdominal cavity.Interleukin-8(IL-8) and its receptor may change the destruction of T lymphocyte surface expression Fas/Fas L system, promote an increase in the apoptosis of cell toxicity T lymphocytes CTL (CTL) cell, and intro-abdominal NK cell activity decline, which helps entopic endometrial plant in celiac escaping the immune monitoring.The increasing of Soluble adhesion molecules between cells-1(SICAM-1) can decrease cell toxicity T (CTL) and lymphatic target cells (endometrial cells) union which lead the adhesion and killer function of its target cells, and make the NK cell activity closed or weakened. It can weaken the leading function of NK cells in the immune monitoring process.In the present study, we detect the expression of IL-the8, TNF alpha and SICAM-1between endometriosis patients and normal, study the correlation of the three, investigate the mechanism of the three in endometriosis and the treatment of endometriosis.Materials and method1. We collected69samples of patients from July2010to July2011in the gynecology of the second affiliated hospital of Zhengzhou university.36patients with EM (20women with stage Ⅰ-Ⅱ,16women with stage III-IV),33cases of control group women (for other benign disease by laparoscopic surgery, or confirmed by operation or pelvic examination).The selection standard of research object:EM group and control group were had no endocrine, immune or metabolic disease, who had a regular menstruation were preoperative3months and not used any hormone therapy.2. The serum levels of TNF-α、IL-8and SICAM-1in endometritis patients and control patients were determined by ELISA. The results processing used SPSS17.0statistical software system to analyze, with P<0.05for differences with a statistical significance.The results1. The serum levels of TNF alpha, IL-8, SICAM-1in EM were higher than those in control group(P<0.05). The serum levels of TNF alpha, IL-8, SICAM-1in stage III-IV of EM were higher than that in stage I-II(P<0.05).2. The serum level of IL-8, SICAM-1and TNF alpha level were linear related, IL-8and SICAM-1level were not linear related.3. The specificity of TNF alpha, IL-8and SICAM-1were48.48%、45.45%and60.61%; and the sensitivity of the three were44.44%、47.22%and69.44%.Conclusion1. TNF alpha, IL-8and SICAM-1were involved in the pathogenesis of EM, and the three was synergistic.2. Serum SICAM-1had higher sensitivity and specificity, so it was expected to become a clinical diagnosis of EM.更多还原