Academic Unit of Obstetrics and Gynaecology, IRCCS San Martino Hospital, Genoa, Italy.
Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DiNOGMI), IRCCS San Martino Hospital, Genoa, Italy.
Hum Reprod. 2023 Apr 3;38(4):621-628. doi: 10.1093/humrep/dead014.
Is there a possible etiologic link between cervical stiffness and adenomyosis?
Women with adenomyosis have a stiffer internal cervical os than those without adenomyosis.
An increased myometrial contractility during menses, leading to breaches in the endometrial basal lamina and subsequent infiltration of endometrial cells into the myometrium, has been proposed as a possible pathogenic mechanism for adenomyosis. Intense menstrual pain has already been shown to be associated with an increased stiffness, at elastography, of the internal cervical os.
STUDY DESIGN, SIZE, DURATION: A cross-sectional study on 275 women was performed between 1 February and 31 July 2022.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Among the participants, 103 were and 172 women were not affected by adenomyosis as evaluated by ultrasonography. General and clinical characteristics of the patients were collected. Strain elastography was used to document tissue stiffness at different regions of interest of the cervix, i.e. the internal cervical os, the middle cervical canal, the anterior and the posterior cervical compartment. Tissue stiffness was expressed as a colour score from 0.1 = blue/violet (high stiffness) to 3.0 = red (low stiffness). Simple and multiple logistic regression analyses were used to evaluate the relation between the presence of adenomyosis, as the dependent variable, and independent factors.
Women with adenomyosis had a higher prevalence (P = 0.0001) and intensity (P = 0.0001) of pain during menses, between menses and at intercourse compared to control. The internal cervical os colour score was lower (higher stiffness) in women with adenomyosis (0.55 ± 0.29 versus 0.67 ± 0.26; P = 0.001) and the middle cervical canal/internal cervical os colour score ratio was greater (3.32 ± 4.36 versus 2.59 ± 4.99; P = 0.008), compared to controls. Upon logistic regression modelling (R2 = 0.077), the internal cervical os stiffness was an independent factor related to adenomyosis (odds ratio (OR) 0.220, 95% CI 0.077, 0.627; P = 0.005) along with age (P = 0.005) and the use of gonadal steroid therapies (P = 0.002). We obtained the same results using a different logistic regression model (R2 = 0.069), by substituting the internal cervical os stiffness with the ratio of the middle cervical canal/internal cervical os stiffness (OR 1.157, 95% CI 1.024, 1.309; P = 0.019).
LIMITATIONS, REASONS FOR CAUTION: Women did not undergo surgery therefore we have no histological confirmation of the adenomyosis diagnosis. Strain elastography is a semiquantitative analysis and can be conditioned by the force applied by the operator during the analysis. The data were obtained mainly in White women in a single centre.
To the best of our knowledge, this is the first study indicating that women with adenomyosis have an increased stiffness of the internal cervical os. The results indicate that a stiff internal cervical os, as determined by elastography, is a possible contributor to the development of adenomyosis. These findings may have clinical significance and should prompt further investigation.
STUDY FUNDING/COMPETING INTEREST(S): None.
N/A.
宫颈僵硬与子宫腺肌病之间是否存在可能的病因联系？
患有子宫腺肌病的女性的宫颈内口比没有子宫腺肌病的女性更僵硬。
在月经期间，子宫平滑肌的收缩力增加，导致子宫内膜基底层破裂，随后子宫内膜细胞渗透到子宫肌层，这被认为是子宫腺肌病的一种可能发病机制。已经表明，剧烈的月经痛与宫颈内口的弹性成像硬度增加有关。
研究设计、大小和持续时间：在 2022 年 2 月 1 日至 7 月 31 日期间，对 275 名女性进行了横断面研究。
参与者/材料、设置、方法：在参与者中，103 名女性患有超声评估的腺肌病，172 名女性没有患有腺肌病。收集了患者的一般和临床特征。使用应变弹性成像记录宫颈不同感兴趣区域的组织硬度，即宫颈内口、宫颈中段、宫颈前和宫颈后腔。组织硬度表示为颜色评分，范围从 0.1=蓝色/紫色（高硬度）到 3.0=红色（低硬度）。简单和多元逻辑回归分析用于评估存在腺肌病（作为因变量）与独立因素之间的关系。
患有腺肌病的女性在月经期间、月经之间和性交时疼痛的发生率（P=0.0001）和强度（P=0.0001）更高。与对照组相比，腺肌病患者的宫颈内口颜色评分较低（较高的硬度）（0.55±0.29 与 0.67±0.26；P=0.001），宫颈中段/宫颈内口颜色评分比值较大（3.32±4.36 与 2.59±4.99；P=0.008）。在逻辑回归模型（R2=0.077）中，宫颈内口硬度是与腺肌病相关的独立因素（比值比（OR）0.220，95%置信区间（CI）0.077，0.627；P=0.005），同时与年龄（P=0.005）和性腺类固醇治疗的使用（P=0.002）相关。我们使用另一个逻辑回归模型（R2=0.069）获得了相同的结果，用宫颈中段/宫颈内口硬度比值代替宫颈内口硬度（OR 1.157，95%CI 1.024，1.309；P=0.019）。
局限性、谨慎的原因：女性未接受手术，因此我们没有腺肌病诊断的组织学证实。应变弹性成像为半定量分析，可能受到操作者在分析过程中施加的力的影响。数据主要来自于单一中心的白人女性。
据我们所知，这是第一项表明患有子宫腺肌病的女性宫颈内口僵硬的研究。结果表明，通过弹性成像确定的僵硬的宫颈内口可能是子宫腺肌病发展的一个可能原因。这些发现可能具有临床意义，并应促使进一步研究。
研究资金/竞争利益：无。
无。
