From the Departments of Obstetrics and Gynecology, Pathology, and Public Health & Preventative Medicine, Oregon Health & Science University, Portland, Oregon.
Obstet Gynecol. 2011 Jun;117(6):1307-1313. doi: 10.1097/AOG.0b013e31821c33dc.
To assess whether primary and secondary vestibulodynia represent different pathologic pathways.
This was an analysis of archived vestibulectomy specimens from 88 premenopausal women with vestibulodynia (2002-2008). Patient records were reviewed to classify the type of vestibulodynia, duration of symptoms, and hormone status. Histologic sections were stained for hematoxylin and eosin to grade inflammation, S100 to highlight nerves, CD117 for mast cells, estrogen receptor α, and progesterone receptor. Differences between primary and secondary vestibulodynia were tested by t tests, chi-square analysis, and linear and logistic regression.
Primary vestibulodynia showed significant neural hypertrophy and hyperplasia (P=.02, adjusted odds ratio [OR] 3.01, 95% confidence interval [CI] 1.2-7.6) and increased progesterone receptor nuclear immunostaining (P=.004, adjusted OR 3.94, CI 1.6-9.9) compared with secondary vestibulodynia. Estrogen receptor α expression was also greater in primary vestibulodynia when symptom diagnosis was less than 5 years (P=.004, adjusted OR 5.53 CI 1.71-17.91).
Primary and secondary vestibulodynia have significantly different histologic features, suggesting that they may have separate mechanistic pathways. Clinically, this may mean the discovery of distinct conditions.
评估原发性和继发性前庭痛是否代表不同的病理途径。
这是对 88 例患有前庭痛的绝经前妇女（2002-2008 年）的前庭切除术标本进行的分析。回顾患者记录以对前庭痛的类型、症状持续时间和激素状态进行分类。对组织学切片进行苏木精和曙红染色以分级炎症，S100 突出神经，CD117 突出肥大细胞，雌激素受体α和孕激素受体。通过 t 检验、卡方分析以及线性和逻辑回归检验原发性和继发性前庭痛之间的差异。
与继发性前庭痛相比，原发性前庭痛表现出明显的神经肥大和增生（P=.02，调整后的优势比[OR]3.01，95%置信区间[CI]1.2-7.6）和孕激素受体核免疫染色增加（P=.004，调整后的 OR 3.94，CI 1.6-9.9）。当症状诊断小于 5 年时，原发性前庭痛中雌激素受体α的表达也更高（P=.004，调整后的 OR 5.53 CI 1.71-17.91）。
原发性和继发性前庭痛具有明显不同的组织学特征，表明它们可能具有不同的发病机制途径。从临床角度来看，这可能意味着发现了不同的病症。
