干细胞与子宫内膜异位症发病机制的研究进展

Research Progress of Stem Cells in the Pathogenesis of Endometriosis

子宫内膜异位症(endometriosis,EMs)在育龄妇女中的发病率近15%,其发病机制一直是研究的热点,经典的"经血逆流与种植学说"不断受到挑战,无法解释如盆腔外远处病灶及特殊部位异位病灶的发生等问题,而干细胞学说尝试从"一元论"角度解释所有类型异位病灶的发生。参与EMs异位病灶的干细胞可能来源于子宫内膜、骨髓、卵巢及其他来源。而雌激素、趋化因子、表皮生长因子、血小板源性生长因子等多种因子参与成体干细胞的分化。微小RNA水平与表观遗传学改变可能参与调控间充质干细胞向子宫内膜样细胞的分化过程。异常定植的干细胞可能改变子宫的容受性,导致不孕、流产等不良生育结局。在形成的不同类型EMs病灶中,腹膜型与深部浸润型病灶干细胞基因表达相似,而与在位内膜干细胞基因表达存在差异。随着研究的不断深入,干细胞在妇产科领域的应用越来越广,在治疗卵巢功能早衰、Asherman综合征、EMs相关性不孕及靶向药物研发方面前景广阔。

The incidence of endometriosis is nearly 15% among women of childbearing age with the pathogenesis been a research focus. The classic theory may encounter plentiful challenges, because it can ′ t account for the occurrence of ectopic lesions located in special areas distant from pelvic, while stem cell theory tries to demonstrate the pathogenesis of various kinds of ectopic lesions with "monism" point of view. Adult stem cells involved in endometriosis lesions may originate from the endometrium, bone marrow, ovary and other sources. Various kinds of molecules, such as estrogen, chemokines, epidermal growth factor, platelet-derived growth factor and other factors involved in differentiation of adult stem cell. The change of micro RNA levels and epigenetic may be related to regulate the differentiation of mesenchyme stem cells into endometrial-like cells. Abnormal colonization of stem cells may change the uterine receptivity, leading to infertility, miscarriage and other adverse reproductive outcomes. Among different types of endometriosis formed, the gene expression of stem cells of peritoneal and deep infiltrating was similar, which is different from that of eutopic endometrial stem cells. With the deepening of research,stem cells are commonly used in the field of obstetrics and gynecology and have promising prospects in the treatment of premature ovarian failure, Asherman syndrome, endometriosis related infertility and targeted drug development