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目的探讨子宫腺肌病的子宫内膜-肌层交界区(EMI)蠕动异常是否导致神经损伤或异常增殖。方法选择2013年10月至2015年10月在大连大学附属中山医院妇科病房行全子宫切除术患者50例。其中弥漫性子宫腺肌病子宫标本25例为观察组,同期行子宫切除的CINⅢ及子宫肌瘤标本25例为对照组。分别于标本宫底及宫体EMI取材,石蜡切片HE染色确诊后免疫组化检测宫底及宫体EMI中NGF表达,了解神经损伤情况。免疫荧光检测宫底及宫体EMI中PGP 9.5表达,了解神经密度改变。并分析子宫腺肌病患者宫底及宫体EMI中NGF的表达强度与PGP9.5密度的相关性。结果 (1)观察组宫底EMI中NGF表达强度与PGP9.5阳性神经纤维密度(7.11±1.08),(16.36±1.76)条/mm2,高于宫体(4.80±0.74),(11.04±2.18)条/mm2,差异有统计学意义(P<0.05)。(2)对照组宫底EMI中NGF表达强度与PGP9.5阳性神经纤维密度1.67,(11.04±2.18)条/mm2与宫体部1.33,(6.87±1.42)条/m2比较,差异无统计学意义(P>0.05)。(3)观察组宫底及宫体NGF的表达强度与PGP9.5阳性神经纤维密度均高于对照组相应部位,差异有统计学意义(P<0.05)。(4)观察组宫底及宫体EMI处NGF表达强度与PGP9.5阳性神经纤维密度呈正相关(分别为r=0.760,P<0.05;r=0.763,P<0.05)。结论 EMI神经异常可能参与子宫腺肌病发生发展,采用手术或药物减少EMI可能治疗子宫腺肌病。
Objective To investigate whether abnormal peristalsis of the endometrium-myometrial junctional area (EMI) in adenomyosis leads to nerve injury or abnormal proliferation. Methods From October 2013 to October 2015, 50 patients underwent hysterectomy in the gynecological ward of Zhongshan Hospital Affiliated to Dalian University. 25 cases of diffuse adenomyosis uterus specimens for the observation group, the same period of hysterectomy CIN Ⅲ and uterine fibroids specimens 25 cases for the control group. Respectively in the specimen at the end of the Palace and the Palace of EMI material, paraffin sections HE staining immunohistochemical detection of uterus and Palace of EMI NGF expression, understanding of nerve injury. Immunofluorescence detection of uterus and Palace of EMI PGP 9.5 expression, to understand changes in nerve density. And analyze the correlation between the expression intensity of NGF and the density of PGP9.5 in the uterine fundus and uterine body of patients with adenomyosis. Results (1) The intensity of expression of NGF in EMG in observation group was significantly higher than that in PGP9.5 positive nerve fibers (7.11 ± 1.08), (16.36 ± 1.76) / mm2, higher than that in uterus (4.10 ± 2.74), (11.04 ± 2.18) ) / Mm2, the difference was statistically significant (P <0.05). (2) There was no significant difference in the expression of NGF and PGP9.5-positive nerve fiber density between the control group and the palace floor EMI (1.67 ± 2.18) / mm2 and 1.33 (6.87 ± 1.42) / m2 Significance (P> 0.05). (3) The expression intensity of NGF and the density of PGP9.5-positive nerve fibers in the palace fundus and the uterus in the observation group were higher than those in the control group (P <0.05). (4) There was a positive correlation between the expression of NGF and the density of PGP9.5 positive nerve fibers in the esophageal mucosa at the end of Palace and in the Palace (r = 0.760, P <0.05; r = 0.763, P <0.05). Conclusion EMI nerve abnormalities may be involved in the development of adenomyosis, surgery or drugs to reduce EMI may be the treatment of adenomyosis.