Gleicher N
Center for Human Reproduction, Chicago, Illinois.
Acta Obstet Gynecol Scand Suppl. 1994;159:15-7.
In many ways endometriosis represents yet another form of unexplained infertility. The disease is clearly associated with a decrease in fecundity and while in advanced stages of the condition this infertility can be attributed to tubal factors, in mild stages of the disease the cause for the decrease in fertility is unknown. As in unexplained infertility, we have suggested that the impairment in fertility is due to autoantibody abnormalities. Endometriosis patients exhibit the same immunologic profile as previously described in women with unexplained infertility and repeated pregnancy loss. In fact, endometriosis is not only characterized by unexplained infertility but also by repeated and excessive pregnancy wastage. Its clinical presentation mimics that of an autoimmune disease, raising the question whether endometriosis is, in fact, an autoimmune disease. Endometriosis demonstrates immunologic abnormalities not only in respect to autoreactivity. Abnormalities in immune function have been widely reported in reference to almost any lymphocyte and macrophage function and, once again, the similarity to findings in patients with unexplained infertility is blatant. Abnormalities can be found in peripheral blood and especially prominently in peritoneal fluid. Treatment of immunologic abnormalities, and especially of autoantibody abnormalities, restores a level of fertility in endometriosis patients. It has also been demonstrated, in an animal model, that non-specific immune modulation may improve fertility.
在许多方面，子宫内膜异位症代表了另一种不明原因的不孕症形式。该疾病显然与生育力下降有关，在病情晚期，这种不孕症可归因于输卵管因素，但在疾病的轻度阶段，生育力下降的原因尚不清楚。正如在不明原因的不孕症中一样，我们认为生育力受损是由于自身抗体异常。子宫内膜异位症患者表现出与先前描述的不明原因不孕症和反复流产女性相同的免疫特征。事实上，子宫内膜异位症不仅以不明原因的不孕症为特征，还以反复和过度的妊娠丢失为特征。其临床表现类似于自身免疫性疾病，这就提出了一个问题，即子宫内膜异位症实际上是否是一种自身免疫性疾病。子宫内膜异位症不仅在自身反应性方面表现出免疫异常。几乎在任何淋巴细胞和巨噬细胞功能方面都广泛报道了免疫功能异常，而且与不明原因不孕症患者的发现再次明显相似。在外周血中可以发现异常，尤其是在腹腔液中异常更为明显。对免疫异常，尤其是自身抗体异常的治疗可恢复子宫内膜异位症患者的一定生育水平。在动物模型中也已证明，非特异性免疫调节可能会提高生育力。
