慢性盆腔疼痛的致痛机制研究
The Mechanism Research of Chronic Pelvic Pain
DOI: 10.12677/ACM.2017.72021, PDF, HTML, XML, 下载: 1,667  浏览: 3,770  国家自然科学基金支持
作者: 沈宇凤:上海中医药大学附属龙华临床医学院,上海;付金荣:上海中医药大学附属龙华医院妇科,上海
关键词: 慢性盆腔痛致痛机制机械压力炎症因子神经肽类Chronic Pelvic Pain Mechanism of Pain Mechanical Pressure Inflammatory Cytokines Neuropeptides
摘要: 慢性盆腔疼痛是妇科的常见病、多发病,病因复杂,诊断困难,常见疾病有子宫内膜异位症、盆腔炎性疾病、盆腔脏器脱垂、尾骨痛等。疼痛是一种伤害性感受,慢性盆腔疼痛的发生是疼痛神经传导的过程,机械压力和炎症的刺激是慢性盆腔疼痛产生的主要原因,在疼痛的神经传导过程中,神经肽类物质也参与慢性疼痛的调控。
Abstract: Chronic pelvic pain (CPP) is a common and frequent gynaecological disease, whose etiology is complex, difficult to diagnosed and involves diseases of multiple systems, common diseases such as endometriosis, pelvic inflammatory disease, interstitial cystitis, irritable bowel syndrome and pelvic organ prolapse, tail bone pain, et al. Pain is a kind of nociceptive feeling. The occurrence of CPP is pain nerve conduction process, mechanical stress and inflammation stimulation are the two main reasons of CPP, in the process of the nerve conduction of pain, neuropeptides are also involved in the regulation of chronic pain.
文章引用:沈宇凤, 付金荣. 慢性盆腔疼痛的致痛机制研究[J]. 临床医学进展, 2017, 7(2): 130-136. https://doi.org/10.12677/ACM.2017.72021

参考文献

[1] 曹泽毅. 中华妇产科学[M]. 北京: 人民卫生出版社, 2010: 388.
[2] Auconnier, A., Chapron, C., Dubuisson, J.B., et a1. (2002) Relation between Pain Symptoms and the Anatomic Location of Deep Infiltrating Endometriosis. Fertility Sterility, 78, 719-726.
https://doi.org/10.1016/S0015-0282(02)03331-9
[3] Fauconnier, A. and Chapron, C. (2005) Endometriosis and Pelvic Pain: Evidence of the Relationship and Implications. Human Reproduction Update, 11, 595-606.
https://doi.org/10.1093/humupd/dmi029
[4] Chapron, C. (2003) Chronic Pelvic Pain and Endometriosis. Journal De Gynecologie, Obstetrique Et Biologie De La Reproduction, 32, S32-S36.
[5] 狄文, 梁舟. 妇科恶性肿瘤与盆腔痛[J]. 中国实用妇科与产科杂志, 2013, 39(3): 173-175.
[6] Maigne, J.Y., Doursounian, L. and Chatellier, G. (2000) Causes and Mechanisms of Common Coccydynia: Role of Body Mass Index and Coccygeal Trauma. Spine (Phila Pa1976), 25, 3072-3079.
[7] Herbein, G. and O'brien, W.A. (2000) Tumor Necrosis Factor (TNF)-Alpha and TNF Receptors in Viral Pathogenesis. Proceedings of the Society for Experimental Biology and Medicine, 223, 241-257.
[8] 潘文霞. TNF-α和IL-37在子宫内膜异位症不孕女性腹腔液中的表达及临床意义[J]. 中国妇幼保健, 2017, 32(2): 335-337.
[9] 焦路阳, 郭庆合, 鲁广建. 血清TNF-α, IL-6与IL-8在子宫内膜异位症中的检测及意义[J]. 现代预防医学, 2012, 39(17): 4540-4541.
[10] 况燕, 徐红, 何中慧, 等. 动态检测子宫内膜异位症患者血清TNF-α的临床意义[J]. 广西医学, 2010, 32(11): 1320-1322.
[11] 罗艳琴, 马云, 宋路瑶, 等. 菝葜活性成份对慢性盆腔炎大鼠子宫组织肿瘤坏死因子-ɑ和白介素-4的影响[J]. 南方医科大学学报, 2014, 34(2): 236-240.
[12] Xin, L., Qing, H., Choon, N., et al. (2010) Chrysin Sensitizes Tumor Necrosis Factor-α-Induced Apoptosis in Human Tumor Cells via Suppression of Nuclear Factor-kappaB. Cancer Letters, 293, 109-116.
https://doi.org/10.1016/j.canlet.2010.01.002
[13] 赵杰, 刘芳. 千金片对慢性盆腔炎大鼠Th1/2型细胞因子表达的影响[J]. 中国老年学杂志, 2017, 37(1): 32-34.
[14] 郑安桔, 欧萍, 闫丽燕, 等. 子宫内膜异位症患者细胞因子表达及与盆腔粘连的相关性研究[J]. 浙江创伤外科, 2015, 20(1): 1-4.
[15] 邓晓杨, 徐蕾, 朱晓莺, 等. 子宫腺肌病患者血清IL-10、IFN-γ的测定及其临床意义[J]. 中国实验诊断学, 2014, 18(10): 1657-1659.
[16] 张秋慧, 匡继林, 李萍. 盆炎方对盆腔炎性疾病后遗症大鼠卵巢、子宫组织TGF-β1、TβRⅡ蛋白的影响[J]. 上海中医药杂志, 2016, 50(2): 84-88.
[17] Donatelli, S.S., Zhou, J.M., Gilvary, D.L., et al. (2014) TGF-β-Inducible microRNA-183 Silences Tumor-Associated Natural Killer Cells. Proceedings of the National Academy of Sciences of the United States of America, 111, 4203-4208.
https://doi.org/10.1073/pnas.1319269111
[18] Matsuzaki, S. and Darcha, C. (2013) Involvement of the Wnt/β-Catenin Signaling Pathway in the Cellular and Molecular Mechanisms of Fibrosis in Endometriosis. PLoS ONE, 8, e76808.
https://doi.org/10.1371/journal.pone.0076808
[19] Young, V.J., Brown, J.K., Maybin, J., et al. (2014) Transforming Growth Factor-β Induced Warburg-Like Metabolic Reprogramming May Underpin the Development of Peritoneal Endometriosis. The Journal of Clinical Endocrinology & Metabolism, 99, 3450-3459.
https://doi.org/10.1210/jc.2014-1026
[20] 胡艳, 李环, 古漪玲, 等. P物质在子宫内膜异位症所致慢性盆腔疼痛患者子宫骶韧带中的表达[J]. 中国微创外科杂志, 2016, 16(4): 355-358.
[21] 王鑫, 乔海, 张瑞涛, 等. HIFU联合LNG-IUS治疗子宫腺肌病的临床对照研究[J]. 现代医药卫生, 2015, 31(12): 1767-1769.
[22] 付金荣, 董肇杨, 李祥云. 血管加压素与子宫内膜异位症疼痛的关系及中药对其的影响[J]. 上海中医药杂志, 2000, 35(10): 10-11.
[23] Mechsner, S., Grum, B., Gericke, C., et al. (2010) Possible Roles of Oxytocin Receptor and Vasopres-sin-1α Receptor in the Pathomechanism of Dysperistalsis and Dysmenorrhea in Patients with Adenomyosis Uteri. Fer-tility Sterilty, 94, 2541-2546.
https://doi.org/10.1016/j.fertnstert.2010.03.015
[24] 夏智群, 王国林. 神经生长因子在炎性疼痛中的作用[J]. 天津医药, 2006, 34(10): 719-721.
[25] Barcena de Arellano, M.L., Arnold, J., Vercellino, F., et al. (2011) Overexpression of Nerve Growth Factor in Peritoneal Fluid from Women with Endometriosis May Promote Neurite Outgrowth in Endometriotic Lesions. Fertility Sterilty, 95, 1123-1126.
https://doi.org/10.1016/j.fertnstert.2010.10.023
[26] 邵世清, 韦业平, 邓丽, 等. 盆腔器官脱垂患者阴道壁和子宫骶、主韧带组织中神经纤维特点和VIP、NPY蛋白的表达[J]. 郑州大学学报(医学版), 2015, 50(2): 252-255.
[27] 滕莉荣. 妊娠及阴道分娩后产妇盆底组织神经病理研究[D]: [博士学位论文]. 北京: 中国协和医科大学, 2007.
[28] 王秀萍, 郭政. 降钙素基因相关肽与疼痛和免疫炎症反应[J]. 山西医药杂志, 2005, 34(6): 481-483.
[29] 何焱玲, 丁桂凤, 夏冬岚, 等. 降钙素基因相关肽诱导人单核细胞合成趋化因子白细胞介素8的研究[J]. 中华医学杂志, 2002, 82(2): 62-65.
[30] Opree, A. and Kress, M. (2000) Involvement of the Proinflamma-tory Cytokinestumor Necrosis Factor-Alpha, IL-1 Beta, and IL-6 but Not IL-8 in the Development of Heat Hyperalgesia: Effects on Heat-Evoked Calcitonin Gene-Related Peptide Release from Rat Skin. Neuroscience, 20, 6289-6293.
[31] Ballet, S., Aubel, B., Mauborgne, A., et al. (2001) The Novel Analgesic, Cizolirtine, Inhibits the Spinal Release of Substance P and CGRP in Rats. Neuropharmacology, 40, 578-589.
https://doi.org/10.1016/S0028-3908(00)00186-6
[32] 雷洁莹. 中药灌肠结合调情志治疗盆腔炎性慢性盆腔痛的临床研究[J]. 新中医, 2012, 44(11): 71-74.
[33] 刘桂兰, 石晶, 赵铭宇, 等. 异痛消对子宫内膜异位症患者血浆TXB2、6-keto-PGF1α及β-EP表达的相关研究[J]. 中国中医药现代远程教育, 201, 11(24): 157-160.
[34] 刘彦, 张爱萍. 艾灸子宫穴治疗产后腹痛临床观察[J]. 新中医, 2014, 46(11): 184-185.
[35] 董小秋, 孙捷豪, 周日勇. 硫酸镁在妇科开腹子宫全切术术后镇痛中的应用效果研究[J]. 中国循证医学杂志, 2014, 14(8): 911-914.