宫腔造影在子宫腺肌病临床分型中的应用及可能机制的初步研究

Study on the application and possible pathogenesis of sonohysterography in the clinical classification of adenomyosis

目的 :探讨宫腔声学造影对子宫腺肌病临床分型的应用及可能机制。方法 :对58例子宫腺肌病患者术前行常规超声及双氧水宫腔造影检查,术中行标本剖视,术后行免疫组化染色法检测巨噬细胞CD68、IL-6在子宫腺肌病结合带组织中的表达,以同期54例子宫肌瘤为对照。结果:(1)子宫腺肌病42例造影阳性中38例为弥漫型,4例为局限型,16例造影阴性均为局限型,术中剖视标本见造影阳性者异位病灶与在位内膜有直接通道,造影阴性者无通道相连,可以依据宫腔造影下有无造影剂弥散将子宫腺肌症分为连续型及间断型。(2)巨噬细胞CD68、IL-6在子宫腺肌病结合带组织中的表达均数分别为25.02±3.21、10.62±2.49,均高于其在子宫肌瘤结合带组织中的表达11.15±2.30、6.59±1.54(均P<0.001)。(3)巨噬细胞CD68、IL-6在连续型子宫腺肌病结合带组织中的表达均数分别为25.57±3.36、11.12±2.49,均高于其在间断型结合带组织中的表达23.56±2.28、9.31±2.02(均P<0.05)。结论 :可依据宫腔造影的方法将子宫腺肌病分型为连续型及间断型,CD68、IL-6可能参与了腺肌病的发生发展,在连续型子宫腺肌病的发病中可能发挥更为重要的作用。

Objective：To explore the significance of sonohysterography in classification to adenomyosis and its pos-sible pathogenesis. Methods：58 cases of adenomyotic patients underwent routine transvaginal sonography （TVS） and transvaginal sonohysterography （SHG） before operation,surgical exploration in operation and immunohistochemical staining was used to detect the expression of CD68 and IL-6 in junction zone specimens after operation, and compared with 54 cases of patients with leiomyoma. Results：（1）Postivity was shown in sonohysterography for 42 cases of adenomyotic pa-tients including 38 cases of diffused type and 4 cases of localized type, while negativity was shown in 16 cases of localized type. There were community passway between eutopic endometrium and ectopic tissue in positive patients, which was dis-covered in surgery ,and none in negative. adenomyosis could be divided into continuous type and discontinuity type accord-ing to sonohysterography. （2）The expressions of CD68 and IL-6 in junction zone in adenomyosis group were 25.02 ±3.21 and 10.62±2.49, significantly higher than those in leiomyom group, which were 11.15±2.30 and 6.59±1.54 （P〈0.001）.（3） The expressions of CD68 and IL-6 in junction zone in continuous type of adenomyosis were 25.57 ±3.36 and 11.12 ±2.49, higher than those in discontinuity type, which were 23.56±2.28 and 9.31±2.02（P〈0.05）. Conclusion：Adenomyosis could be divided into continuous type and discontinuity type according to sonohysterography .CD68 and IL-6 may play an important role in the pathogenesis of adenomypsis,especially for continuous type adenomyosis.