Dmowski W P, Ding J, Shen J, Rana N, Fernandez B B, Braun D P
Institute for the Study and Treatment of Endometriosis, Oak Brook, IL 60523, USA.
Hum Reprod. 2001 Sep;16(9):1802-8. doi: 10.1093/humrep/16.9.1802.
The aetiology of endometriosis is unknown. Ectopic dissemination of the endometrial cells gives origin to endometriotic lesions, but occurs in women with and without endometriosis. It has been suggested that increased ectopic cell survival facilitates their implantation. The objectives of this study were to evaluate endometrial apoptosis in women with endometriosis according to: (i) cyclic changes, (ii) glandular and stromal contribution, and (iii) stage of the disease.
The subjects were women undergoing diagnostic laparoscopy and endometrial biopsies for suspected endometriosis. Spontaneous apoptosis was evaluated using TdT-mediated dUTP-biotin nick end-labelling (TUNEL) assay. Apoptotic cells per 10 mm(2) (apoptotic index) in an area of 10-50 mm(2) in 5 microm endometrial tissue sections were counted and location of these cells was recorded.
The apoptotic index in glandular epithelium was lower in endometriosis than controls (26.0 +/- 5.5 versus 51.2 +/- 9.7, P = 0.03) but not in the stroma (36.3 +/- 6.4 versus 48.4 +/- 11.3, NS). In controls, apoptosis was highest during the late secretory/menstrual and early proliferative phases and cyclic variability was apparent. In endometriosis, this cyclic variability was lost. There was a trend toward decreased apoptosis with increasing stage of the disease, but the differences lacked statistical significance.
Spontaneous apoptosis is decreased in the endometrial glands in women with endometriosis, especially during late secretory/menstrual and early proliferative phases of the cycle. This may indicate increased viability of endometrial cells shed during menses, facilitating their ectopic survival and implantation.
子宫内膜异位症的病因尚不清楚。子宫内膜细胞的异位播散导致子宫内膜异位症病变的发生，但在患有和未患子宫内膜异位症的女性中均会出现。有研究表明，异位细胞存活率的增加有助于其着床。本研究的目的是根据以下方面评估子宫内膜异位症女性的子宫内膜凋亡情况：（i）周期性变化，（ii）腺体和间质的作用，（iii）疾病分期。
研究对象为因疑似子宫内膜异位症而接受诊断性腹腔镜检查和子宫内膜活检的女性。使用TdT介导的dUTP生物素缺口末端标记法（TUNEL法）评估自发凋亡情况。在5微米厚的子宫内膜组织切片中，对10 - 50平方毫米区域内每10平方毫米的凋亡细胞数（凋亡指数）进行计数，并记录这些细胞的位置。
子宫内膜异位症患者腺体上皮的凋亡指数低于对照组（26.0±5.5对51.2±9.7，P = 0.03），但间质中的凋亡指数无差异（36.3±6.4对48.4±11.3，无统计学意义）。在对照组中，凋亡在分泌晚期/月经期和增殖早期最高，且呈现明显的周期性变化。在子宫内膜异位症患者中，这种周期性变化消失。随着疾病分期增加，凋亡有降低趋势，但差异无统计学意义。
子宫内膜异位症女性的子宫内膜腺体自发凋亡减少，尤其是在月经周期的分泌晚期/月经期和增殖早期。这可能表明月经期脱落的子宫内膜细胞活力增加，有利于其异位存活和着床。
