不同类型子宫内膜异位症及其周围组织中Foxp3和CD4^+CD25^+Treg的表达及意义

Expressions and significance of Foxp3 and CD4^+CD25^+Treg in different types of endometriosis tissues and the surrounding tissues

目的探讨不同类型子宫内膜异位症病灶及其周围组织,子宫内膜异位症患者在位子宫内膜非子宫内膜异位症患者在位子宫内膜中叉头状转录因子(Foxp3)和CD4^+、CD25^+调节性T细胞(CD4^+CD25^+Treg)的表达及意义。方法应用免疫组化技术检测卵巢子宫内膜异位囊肿及盆腔腹膜组织各30例,深部子宫内膜异位症及其周围组织各10例,腹壁切口子宫内膜异位及其周围组织各20例,会阴内膜异位症及其周围组织各20例,子宫内膜异位症患者的在位子宫内膜及非子宫内膜异位症患者的在位内膜各30例。结果(1)卵巢子宫内膜异位囊肿与盆腔腹膜组织中Foxp3及CD4^+CD25^+Treg表达率无显著差异;(2)深部子宫内膜异位症,腹壁内膜异位症,会阴内膜异位症(统称特殊部位子宫内膜异位症)病灶与其周围正常组织中相比Foxp3及CD4^+CD25^+Treg表达率明显升高,差异均有统计学意义(均P<0.05);(3)不同部位子宫内膜异位症两两间比较Foxp3及CD4^+CD25^+Treg表达率差异均无统计学意义(均P>0.05);(4)盆腔腹膜与特殊部位子宫内膜异位症周围正常组织组间两两比较,盆腔腹膜组织中Foxp3及CD4^+CD25^+Treg表达率明显升高,差异均有统计学意义(均P<0.05);而特殊部位子宫内膜异位症周围正常组织组间两两比较,差异无统计学意义(P>0.05);(5)子宫内膜异症患者子宫在位内膜与非子宫内膜异症患者子宫在位内膜中相比,子宫内膜异症患者子宫在位内膜组织中Foxp3及CD4^+CD25^+Treg表达率明显升高,差异均有统计学意义(均P<0.05)。结论 Foxp3及CD4^+CD25^+Treg细胞在不同类型子宫内膜异位症患者病灶部位,卵巢子宫内膜异位囊肿的盆腔腹膜以及子宫内膜异位症患者子宫在位内膜组织中的表达显著升高,明显高于特殊部位子宫内膜异位症病灶周围正常组织及非子宫内膜异位患者子宫在位内膜的表达。提示机体免疫异常与不同类型子宫内膜异位症的发生存在密切关系;同时腹腔微环境的免疫异常也可能促进了机体免疫耐受的发展;子宫在位内膜的高表达很大程度上促进了不同类型子宫内膜异位症的发生;特殊部位的子宫内膜异位症可能还存在其他的发病机制。

Objective To explore the expressions and significance of Foxp3 and CD4^＋CD25^＋ Treg in different types of endometriosis tissues and the surrounding tissues （eutopic endometrium in endometriosis patients and eutopic endometrium in patients without endometrio- sis） . Methods Immunohistochemistry was used to detect 30 cases of ovarian endometriosis cyst and pelvic abdominal tissue, 10 cases of deep endometriosis and the surrounding tissues, 20 cases of endometriosis of abdominal incision and the surrounding tissues, 20 cases of per- ineal endometriosis and the surrounding tissues, 30 endometriosis cases of eutopic endometrium, and 30 non-endometriosis cases of eutopic endometrium. Results There was no significant difference in the expression rates of Foxp3 and CD4^＋CD25^＋ Treg between ovarian endome- triosis cyst and pelvic peritoneum. Compared with the surrounding normal tissues, the expression rates of Foxp3 and CD4^＋ CD25^＋ Treg in deep endometriosis, endometriosis of abdominal incision, and perineal endometriosis （umbrella name： endometriosis in special sites） in- creased significantly, there were statistically significant differences （ all P〈0. 05） . There was no statistically significant difference in the ex- pression rates of Foxp3 and CD4^＋CD25^＋ Treg among endometriosis in special sites （all P〈0. 05） . Compared with surrounding normal tis- sues of endometriosis in special sites, the expression rates of Foxp3 and CD4^＋CD25^＋ Treg in pelvic peritoneum increased significantly, there were statistically significant differences （ all P〈0. 05） . There was no statistically significant difference in the expression rates of Foxp3 and CD4^＋ CD25^＋ Treg among endometriosis in special sites （all P〉0. 05 ） . Compared with eutopic endometrium of patients without endometrio- sis, the expression rates of Foxp3 and CD4^＋ CD25^＋ Treg in eutopic endometrium of patients with endometriosis increased significantly, there were statistically significant differences （ all P〈0.05 ） . Conclusion The expression rates of Foxp3 and CD4^＋ CD25^＋ Treg increase in le- sions of patients with different types of endometriosis, pelvic peritoneum of ovarian endometriosis cyst, and eutopic endometrium of patients with endometriosis, which are significantly higher than those in surrounding normal tissues of endometriosis in special sites and eutopic endo- metrium of patients without endometriosis, and it indicates the close relationship between abnormal immunity and occurrence of different types of endometriosis, at the same time, abnormal immunity of pelvic microenvironment may romote the development of immune tolerance, the high expression of eutopic endometrium greatly contributes to the occurrence of different types of endometriosis. There may be other mecha- nisms of endometriosis in specific sites.