Amidifar Sima, Jafari Davood, Mansourabadi Amir Hossein, Sadaghian Sara, Esmaeilzadeh Abdolreza
School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
Department of Immunology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
Am J Reprod Immunol. 2025 Mar;93(3):e70056. doi: 10.1111/aji.70056.
Endometriosis (EMS) is a common chronic gynecological disorder affecting 5%-10% of reproductive-age women, often causing infertility, dyspareunia, pain, and limitations in physical and sexual activities. This condition is defined by the presence of endometrial tissue outside the uterus, commonly explained by Sampson's theory of retrograde menstruation. Although its etiology remains unclear, genetic, epigenetic, hormonal imbalances, oxidative stress, and immune factors play critical roles. Immune dysregulation, involving inflammatory factors, cytokines, and immune cells facilitates the implantation, proliferation, angiogenesis, and development of ectopic endometrial stromal cells (ESCs). Research indicates that the implantation of ESCs in the peritoneum triggers an inflammatory response, recruiting various immune cells and leading to a cycle of inflammation characterized by elevated growth factors and cytokines. In this review, we discuss the immune system's role in EMS pathogenesis, emphasizing the contributions of immune cells, inflammatory mediators, oxidative stress, and so forth. This review also highlights that while current treatments, including hormonal therapies and surgical interventions, aim to alleviate symptoms and improve fertility, emerging evidence suggests that advancements in immunotherapies targeting specific immune cell activities hold promise as innovative future treatment strategies enhancing healthcare management for affected women.
子宫内膜异位症（EMS）是一种常见的慢性妇科疾病，影响5%-10%的育龄妇女，常导致不孕、性交困难、疼痛以及身体和性活动受限。这种病症的定义是子宫外存在子宫内膜组织，通常用桑普森的逆行月经理论来解释。尽管其病因尚不清楚，但遗传、表观遗传、激素失衡、氧化应激和免疫因素起着关键作用。涉及炎症因子、细胞因子和免疫细胞的免疫失调促进了异位子宫内膜间质细胞（ESC）的植入、增殖、血管生成和发育。研究表明，ESC在腹膜中的植入引发炎症反应，招募各种免疫细胞，并导致以生长因子和细胞因子升高为特征的炎症循环。在本综述中，我们讨论免疫系统在EMS发病机制中的作用，强调免疫细胞、炎症介质、氧化应激等的贡献。本综述还强调，虽然目前的治疗方法，包括激素疗法和手术干预，旨在缓解症状和提高生育能力，但新出现的证据表明，针对特定免疫细胞活动的免疫疗法进展有望成为创新的未来治疗策略，改善对受影响女性的医疗管理。
