Iwabe Tomio, Harada Tasuku, Terakawa Naoki
Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan.
Gynecol Obstet Invest. 2002;53 Suppl 1:19-25. doi: 10.1159/000049420.
Endometriosis, which is common in women of reproductive age, may affect fertility. It is also clear that mechanical disruption of the pelvic anatomy may cause infertility. However, our understanding of the association between the early stage of endometriosis and infertility remains incomplete. Bloody peritoneal fluid (PF) is frequently observed in the cul-de-sac of endometriosis patients and contains various biologically active factors. We found that the concentrations of tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6) in PF from patients with endometriosis were significantly higher than that of patients with endometriosis. There were significantly positive correlations between the levels of TNF-alpha and IL-6. We compared the levels of these cytokines with regard to the R-AFS stages and scores, but no differences were observed. In contrast, these cytokines correlate with the number and extent of red color peritoneal endometriosis. TNF-alpha increased the expression of IL-6 messenger RNA and protein in endometriotic stromal cells derived from chocolate cyst in a dose-dependent manner. The addition of IL-6 inhibited the development of mouse preimplantation embryo and impaired sperm function. We concluded that increased levels of IL-6 in peritoneal fluid of patients with active red endometriosis might be related to endometriosis-associated fertility.
子宫内膜异位症在育龄女性中很常见，可能会影响生育能力。盆腔解剖结构的机械性破坏也会导致不孕，这一点也很明确。然而，我们对子宫内膜异位症早期阶段与不孕之间关联的理解仍不完整。血性腹腔液（PF）在子宫内膜异位症患者的直肠子宫陷凹中经常可见，且含有多种生物活性因子。我们发现，子宫内膜异位症患者PF中的肿瘤坏死因子α（TNF-α）和白细胞介素-6（IL-6）浓度显著高于子宫内膜异位症患者。TNF-α和IL-6水平之间存在显著正相关。我们比较了这些细胞因子在R-AFS分期和评分方面的水平，但未观察到差异。相反，这些细胞因子与红色腹膜子宫内膜异位症的数量和范围相关。TNF-α以剂量依赖的方式增加了来自巧克力囊肿的异位内膜间质细胞中IL-6信使核糖核酸和蛋白质的表达。IL-6的添加抑制了小鼠植入前胚胎的发育并损害了精子功能。我们得出结论，活跃的红色子宫内膜异位症患者腹腔液中IL-6水平升高可能与子宫内膜异位症相关的生育能力有关。
