深部浸润型与表浅型子宫内膜异位症者腹腔液Th1、Th2细胞因子变化

Changes of Th1 and Th2 Cytokines in Superficial Endometriosis and Deep Infiltrating Endometriosis

目的:研究深部浸润型与表浅型子宫内膜异位症(EMs)临床特征以及腹腔液Th1、Th2细胞因子的表达差异。方法:收集术后病理证实诊断为EMs患者的临床资料及其腹腔液,根据术中诊断分为:表浅型(腹膜型,n=30)、深部浸润型(n=16);以同期因输卵管因素不孕症行腹腔镜探查的妇女(n=16)为对照组。用ELISA法测定3组腹腔液中IL-2、IL-4、IL-6、IL-10、TNF-α、IFN-γ的表达差异性。结果:表浅型EMs患者年龄较轻、不孕率高、腹水发生率高,而性交痛则是深部浸润型EMs患者的典型临床特征。与对照组相比,EMs组腹腔液中IL-4、IL-6、IL-10、TNF-α表达均升高,IFN-γ在EMs组表达均降低。IL-2仅在深部浸润型EMs组升高;深部浸润型EMs组与表浅型EMs组之间对比,IL-6在表浅型EMs的升高明显(P<0.01),IL-10与TNF-α则在深部浸润型EMs组升高明显(P<0.01),IFN-γ在深部浸润型EMs组下降更为明显(P<0.01),IL-4在2个EMs组间表达无差异。结论:在表浅型与深部浸润型EMs的发病机制中,两者具有不同的免疫学改变。

Objective： To study the clinical characteristics of superficial endometriosis （SE）＇ and deep infiltrating endometriosis （DIE） and the difference of Thl and Th2 cytokines in the peritoneal fluid. Methods： The patients who were diagnosed as endometriosis （EMs） by pathology after operation were collected in this study, excluding the patients with endometrial cyst. All patients were divided into SE group （n=30） and DIE group （n=16） according to the intraoperative diagnosis. Sixteen cases who suffered from laparoscope examination during the same period because of barrenness caused by fallopian tube factors were arranged as the control. The expressional differences of IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-y in the peritoneal fluid were measured by ELISA. Results： For clinical characteristics, the patients with SE were younger than the patients with DIE, higher in incidence of infertility and ascitic fluid while dyspareunia was the typical clinical feature for the patients with DIE. Compared with the control, the expressions of IL-4, IL-6, IL-10, TNF-α in the peritoneal fluid were increased in the patients with EMs while the expression of IFN-Y was reduced. The expression of IL-2 was increased merely in DIE group. Compared with DIE group, the expression of IL-6 was increased significantly in SE group （P〈0.01）. The expressions of IL-10 and TNF-α were increased in DIE group （P〈0.01）. The expression of IFN-Y was reduced obviously in DIE group （P〈0.01）. The expression of IL-4 showed no difference between SE group and DIE group. Conclusion： There are different immunological changes in pathogenesis between superficial en- dometriosis and deep infiltrating endometriosis.