炎症因子与子宫腺肌病发病机制的研究进展

Research Advances in the Pathogenesis of Inflammatory Factors and Adenomyosis

摘要: 子宫腺肌病(adenomyosis, AM)是指子宫肌层内存在异位子宫内膜腺体和间质，多数异位子宫内膜呈弥漫性生长，子宫呈均匀一致的增大，少数腺肌病病灶呈局限性生长形成结节或团块，镜下表现为肌层内有岛状分布的异位内膜腺体及基质，称为子宫腺肌瘤。随着女性生育年龄的推迟，流产等宫腔操作的增加，影像学诊断手段日益精准，AM发病率逐年提高并呈现年轻化趋势，流行病学研究显示，子宫腺肌病患者中月经过多发生率为40%~50%，表现为月经增多持续数个月经周期，继发性痛经进行性加重的发生率为15%~30%，同时与AM相关的女性不孕症及流产、早产等产科不良结局的发生越来越多见，相当一部分有生育要求的患者需借助辅助生殖技术实现生育，这不仅对女性工作、生活以及社会心理影响较大，也造成了很大的医疗及经济负担。AM的治疗目前尚无理想药物及保守手术治疗方案，亟需深入探索其发病机制以提出更有效的防治手段。近年研究发现多个炎症因子在AM中的表达升高，且与AM临床表现密切相关，子宫腺肌病逐渐被认为是一种慢性免疫炎症性疾病，有时涉及局灶组织中的各种免疫细胞和炎性细胞因子，例如白细胞介素-1β (IL-1β)、IL-6、IL-8、IL-10、肿瘤坏死因子-α (TNF-α)等。因此我们推测继发的炎症反应可能作为主要推动力促使AM发生，从而揭示炎症因子调控AM病灶形成中的潜在分子机制，为AM的治疗提供新的思路。

Abstract: Adenomyosis (AM) is a disease in which the endometrial glands and mesenchyme invade the myometrium to form a diffuse or limited disease. With the delay in the reproductive age of women, the increase of uterine operations such as abortion, and the increasing precision of diagnostic imaging methods, the incidence of AM has been increasing year by year and showing a trend of rejuvenation. Epidemiological studies have shown that about 40% to 60% of patients with AM have had excessive menstruation, and 15% to 30% have had progressive worsening of dysmenorrhea, and infertility and adverse obstetric outcomes related to AM are becoming more common. The treatment of AM is still without ideal drugs and conservative surgical treatment options, and an in-depth exploration of its pathogenesis is urgently needed to propose more effective means of prevention and treatment. In recent years, the expression of several inflammatory factors in AM is elevated and closely related to the clinical manifestations of AM, and adenomyosis has been gradually recognized as a chronic immunoinflammatory disease, sometimes involving various immune cells and inflammatory cytokines in focal tissues, such as interleukin-1β (IL-1β), IL-6, IL-8, IL-10, tumor necrosis factor-α (TNF-α)), etc. Therefore, we hypothesized that the secondary inflammatory response may act as a major driving force for AM development, thus revealing the potential molecular mechanisms in the regulation of AM lesion formation by inflammatory factors and providing new ideas for the treatment of AM.