子宫内膜异位症在位、异位内膜淋巴细胞亚群分布的研究

Study on the distribution of lymphocyte subsets in the eutopic and ectopic endometrium of women with endometriosis

目的 探讨子宫内膜异位症 (内异症 )在位和异位内膜淋巴细胞的分布及意义。方法 采用免疫组织化学碱性磷酸酶抗碱性磷酸酶法 ,对 43例内异症患者和 19例子宫肌瘤等非内异症患者 (对照组 )的在位内膜和异位内膜中淋巴细胞及巨噬细胞亚群的数量、比例进行测定。结果 内异症患者的增殖期异位内膜局部CD+3 、CD+8、CD+68T淋巴细胞含量分别为 (6 7 2± 13 5 )个 /5HP( x±s,下同)、(4 5 0± 14 6 )个 /5HP、(37 2± 10 6 )个 /5HP ,明显多于在位内膜的 (5 2 4± 11 3)个 /5HP(P<0 0 1)、(32 5± 10 0 )个 /5HP(P <0 0 5 )、(30 7± 10 3)个 /5HP ,以及对照组内膜的 (5 2 1± 14 9)个 /5HP(P <0 0 5 )、(2 8 9± 12 7)个 /5HP(P <0 0 1)、(2 6 3± 9 3)个 /5HP(P <0 0 5 ) ;分泌期CD+8T淋巴细胞 /CD+4 T淋巴细胞比值、CD+68T淋巴细胞含量分别为 3 5± 1 2、(4 0 3± 12 2 )个 /5HP ,高于对照组内膜的 3 2± 0 8(P <0 0 5 )、(2 8 6± 10 6 )个 /5HP(P <0 0 1) ;巨噬细胞含量也明显增高。异位内膜中淋巴细胞无明显周期性改变。结论 内异症病变局部淋巴细胞和巨噬细胞的大量侵润 ,与内异症的病理形成有关。在较晚期的内异症 ,淋巴细胞和巨噬细胞不能清除异位内膜 ,反之 。

Objective To investigate the abnormal distribution of lymphocytes in eutopic and ectopic endometrium of patients with endometriosis and its significance Methods In 43 cases, biopsies of ectopic tissues were taken by laparoscopy and laparotomy from patients with endometriosis and eutopic endometrium by curettage at the same time In 19 cases, eutopic endometrium was taken from hysterectomy for myomatous uterus Immunohistochemical techniques were employed to demonstrate the difference in the number and ratio of the lymphocyte subsets between the patients with endometriosis and the controls Results In the patients with endometriosis, in the proliferative phase, ectopic endometrium contained respectively CD + 3、CD + 8T cells and CD + 68 macrophages (67 2±13 5)/5HP, (45 0±14 0)/5 HP and (37 2±10 6)/5 HP, significanly higher then that in the eutopic endometriun (52 4±11 3)/5HP ( P <0 01), (32 5±10 0)/5HP ( P <0 05), and (30 7±10 3)/5HP, and also higher as compared with the control group (52 1±14 9)/5HP ( P <0 05), (28 9±12 7)/5HP ( P <0 01), (26 3±9 3)/5HP ( P <0 05); in the secretory phade, CD + 8/CD + 4, and CD + 68 content was respectively 3 5±1 2,(40 3±12 2)/5HP, higher than that in the control group, 3 2±0 8 ( P <0 05), (28 6±10 6)/5HP ( P <0 01) . The number of macrophages was also significantly increased. No cyclic changes in the number of lymphocytes in each subpopulation in ectopic endometrium were found Conclusions In the patients with endometriosis, the changes in T lymphocytes and macrophages are mainly on the endometriotic sites The infiltration of many lymphocytes and macrophages into the ectopic endometrium formed a chronic inflammatory process The lymphocytes are not able to clear the ectopic endometrium in the late stages of endometrium,on the contrary, they stimulate the further growth of the endometrium