Li Yan, Zhang Shaofen, Xu Linna
Department of Gynaecology, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai 200011, China.
Department of Gynaecology, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai 200011, China. Email:
Zhonghua Fu Chan Ke Za Zhi. 2014 Feb;49(2):120-4.
To investigate the expression of nerve growth factor (NGF) in the ectopic endometrium in adenomyosis patients, and explore the relationship between NGF expression and innervation or pain scales.
From Mar. 2009 to Oct. 2009, 45 adenomyosis patients undergoing hysterectomy in Obstetrics and Gynecology Hospital of Fudan University were enrolled in this study, which were classified into 33 cases in pain group and 12 cases in non-pain group based on symptom. The degree of dysmenoreal, chronic pelvic pain and dyspareunia was evaluated by visual analogue scale, including no pain, mild to moderate pain and severe pain group. In the mean time, 26 patients with leiomyoma or cervical intraepithelial neoplasia III (CIN III) undergoing hysterectomy were defined as control group. Ectopic endometrium from experimental group and eutopic endometrium from control group were collected in the surgery. The expression of NGF was examined by immunohistochemistry. The density of protein gene product (PGP) 9.5 positive nerve fibers was detected by immuno-fluorescence.
The NGF level and the density of PGP 9.5 positive nerve fibers in adenomyosis pain group (0.25 ± 0.08, 16 ± 8 )were higher than adenomyosis painless (0.19 ± 0.05, P = 0.007;11 ± 5, P = 0.018) and control group (0.18 ± 0.05, P = 0.000; 9 ± 4, P = 0.000) . The NGF level and the density of PGP9.5 positive nerve fibers in severe dysmenorrheal group (0.29 ± 0.07, 19 ± 10) were higher than mild to moderate dysmenorrheal (0.22 ± 0.07, P = 0.018;13 ± 4, P = 0.035) and painless group (0.18 ± 0.05, P = 0.000;11 ± 5, P = 0.006) of adenomyosis patients. There was no difference of NGF level and the density of PGP 9.5 positive nerve fibers in chronic pelvic pain group and no chronic pelvic pain group of adenomyosis patients, so was dyspareunia group and no dyspareunia group.
The increased NGF level of adenomyosis nodules and improving innervation might be involved in the mechanism of adenomyosis related pain.
研究神经生长因子（NGF）在子宫腺肌病患者异位内膜中的表达，探讨NGF表达与神经支配及疼痛程度的关系。
选取2009年3月至2009年10月在复旦大学附属妇产科医院行子宫切除术的45例子宫腺肌病患者，根据症状分为疼痛组33例和非疼痛组12例。采用视觉模拟评分法评估痛经、慢性盆腔痛及性交痛程度，分为无痛、轻至中度疼痛和重度疼痛组。同时选取26例行子宫切除术的子宫肌瘤或宫颈上皮内瘤变III级（CIN III）患者作为对照组。术中收集试验组异位内膜及对照组在位内膜。采用免疫组织化学法检测NGF表达，免疫荧光法检测蛋白基因产物（PGP）9.5阳性神经纤维密度。
子宫腺肌病疼痛组NGF水平及PGP 9.5阳性神经纤维密度（0.25±0.08，16±8）高于子宫腺肌病无痛组（0.19±0.05，P = 0.007；11±5，P = 0.018）及对照组（0.18±0.05，P = 0.000；9±4，P = 0.000）。子宫腺肌病患者重度痛经组NGF水平及PGP9.5阳性神经纤维密度（0.29±0.07，19±10）高于轻至中度痛经组（0.22±0.07，P = 0.018；13±4，P = 0.035）及无痛组（0.18±0.05，P = 0.000；11±5，P = 0.006）。子宫腺肌病患者慢性盆腔痛组与无慢性盆腔痛组、性交痛组与无性交痛组的NGF水平及PGP 9.5阳性神经纤维密度无差异。
子宫腺肌病病灶中NGF水平升高及神经支配增加可能参与了子宫腺肌病相关疼痛的发生机制。
