Department of Microbiology, Institute of Biomedical Science, São Paulo University, São Paulo, Brazil; Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquita, Brazil.
Department of Microbiology, Institute of Biomedical Science, São Paulo University, São Paulo, Brazil; Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquita, Brazil.
Fertil Steril. 2018 Mar;109(3):549-560.e4. doi: 10.1016/j.fertnstert.2017.11.009. Epub 2018 Feb 7.
To detect Mollicutes in women with endometriosis and healthy peritoneal tissues and evaluate the participation of these bacteria in the immune response during endometriosis.
Cross-sectional study.
University hospitals.
PATIENT (S): Women with endometriosis (n = 73) and without endometriosis (n = 31).
INTERVENTION(S): Endocervical swabs, peritoneal fluid, and biopsied lesions of endometriosis of women with endometriosis (study group) and healthy peritoneal tissues (control group) were collected during surgery. Clinical characteristics were registered before surgery.
MAIN OUTCOME MEASURE(S): We determined the infectious agents with the use of quantitative polymerase chain reaction (PCR). The cytokine secretion profile was determined with the use of Luminex. The expression of immune response related genes was determined with the use of a PCR array kit.
RESULT(S): All target microorganisms were detected at least once in the swab samples analyzed. It was possible to observe higher diversity of microorganisms in the samples of swab and peritoneal fluid in the study group compared with the control. Ureaplasma parvum was associated with the severity of the symptom dyspareunia. Mycoplasma genitalium was associated with higher production of interferon-γ and interleukin-1β. Genes of inflammatory response activation and antigen presentation were up-regulated in biopsied tissue of women with endometriosis. In women with endometriosis, peritoneal fluid cells showed a down-regulation of genes associated with the inflammatory response. This down-regulation profile was higher in presence of M. genitalium.
CONCLUSION(S): Mycoplasma genitalium may play a key role in the immune tolerance process and, especially, the aggravation of this profile. More studies are needed to understand this immune tolerance profile of bacterial infections.
检测子宫内膜异位症和健康腹膜组织中的支原体，并评估这些细菌在子宫内膜异位症免疫反应中的参与。
横断面研究。
大学医院。
患者（s）：子宫内膜异位症患者（n=73）和非子宫内膜异位症患者（n=31）。
干预（s）：在手术期间采集子宫内膜异位症患者的宫颈拭子、腹膜液和活检病变（研究组）和健康腹膜组织（对照组）。手术前登记了临床特征。
主要观察指标（s）：我们使用定量聚合酶链反应（PCR）确定感染因子。使用 Luminex 测定细胞因子分泌谱。使用 PCR 阵列试剂盒测定免疫反应相关基因的表达。
结果（s）：在所分析的拭子样本中，至少检测到所有目标微生物一次。与对照组相比，研究组的拭子和腹膜液样本中观察到更高的微生物多样性。解脲支原体与性交痛症状的严重程度相关。生殖支原体与干扰素-γ和白细胞介素-1β的产生增加相关。子宫内膜异位症活检组织中炎症反应激活和抗原呈递相关基因上调。在子宫内膜异位症患者中，腹膜液细胞中与炎症反应相关的基因下调。在存在生殖支原体的情况下，这种下调谱更高。
结论（s）：生殖支原体可能在免疫耐受过程中发挥关键作用，特别是在这种谱的加重中。需要更多的研究来了解这种细菌感染的免疫耐受谱。
