子宫内膜异位症中干细胞与免疫炎症机制的 研究进展
Research Advances in Stem Cell-Mediated Immune and Inflammatory Mechanisms in Endometriosis
摘要: 子宫内膜异位症(EMT)是一种慢性激素依赖性炎性疾病,作为常见妇科疾病之一,对患者身心健康与生活质量均产生显著负面影响,且其发病机制至今尚不明确,导致其早诊早治困难,多数病情进展,进而造成不孕甚至癌变。近来,炎症免疫紊乱、子宫内膜细胞异位黏附及细胞异常侵袭增殖等被认为是内异症核心病理环节,干细胞学说及免疫炎症学说已成为EMT发病机制的研究热点,相关炎症通路关键因子及干细胞表面标志物为EMT的发病和诊疗提供了重要参考。本文基于干细胞学说及免疫炎症学说在EMT发病中的作用进行综述,以期为该疾病的发病提供新思路。
Abstract: Endometriosis (EMT) is a chronic hormone-dependent inflammatory disease. As one of the common gynecological conditions, it significantly impacts patients’ physical and mental health as well as their quality of life. Its pathogenesis remains unclear, hindering early diagnosis and treatment. Consequently, most cases progress, leading to infertility or even malignant transformation. Recent research identifies inflammatory immune dysregulation, ectopic adhesion of endometrial cells, and abnormal cellular invasion and proliferation as core pathological mechanisms. The stem cell theory and immune-inflammatory theory have emerged as key research focuses in elucidating EMT pathogenesis. Key factors in related inflammatory pathways and stem cell surface markers provide crucial insights for understanding the disease’s development and guiding its diagnosis and treatment. This review examines the roles of stem cell theory and immune-inflammatory theory in endometriosis pathogenesis, aiming to offer novel insights into the disease’s development.
文章引用:肖婷, 马瑛. 子宫内膜异位症中干细胞与免疫炎症机制的 研究进展[J]. 临床医学进展, 2026, 16(4): 146-155. https://doi.org/10.12677/acm.2026.1641235

参考文献

[1] Zondervan, K.T., Becker, C.M. and Missmer, S.A. (2020) Endometriosis. New England Journal of Medicine, 382, 1244-1256. [Google Scholar] [CrossRef] [PubMed]
[2] Lamceva, J., Uljanovs, R. and Strumfa, I. (2023) The Main Theories on the Pathogenesis of Endometriosis. International Journal of Molecular Sciences, 24, Article 4254. [Google Scholar] [CrossRef] [PubMed]
[3] 陈晓洁, 李晓琼, 吴椒虹. 子宫内膜异位症盆腔疼痛对患者生活质量和心理健康的影响[J]. 中国妇幼保健, 2022, 37(5): 816-819.
[4] Ono, M., Fukuda, M., Yamanoi, K., Sunada, M., Kitamura, S., Taki, M., et al. (2024) Clinical Significance of Initial Symptoms in Endometriosis-Associated Ovarian Cancer. Journal of Turkish Society of Obstetric and Gynecology, 21, 28-36. [Google Scholar] [CrossRef] [PubMed]
[5] Kim, H.S., Kim, T.H., Chung, H.H. and Song, Y.S. (2014) Risk and Prognosis of Ovarian Cancer in Women with Endometriosis: A Meta-Analysis. British Journal of Cancer, 110, 1878-1890. [Google Scholar] [CrossRef] [PubMed]
[6] Wang, D., Yang, Q., Wang, H. and Liu, C. (2021) Malignant Transformation of Hepatic Endometriosis: A Case Report and Literature Review. BMC Womens Health, 21, Article No. 249. [Google Scholar] [CrossRef] [PubMed]
[7] Del Mundo, M.M., Aguilar, M., Chen, H., Niu, S., Sahoo, S.S., Roy, S., et al. (2025) β-Catenin, PAX2, and PTEN Aberrancy across the Spectrum of Endometrioid Ovarian Lesions. International Journal of Gynecological Pathology, 44, 79-87. [Google Scholar] [CrossRef] [PubMed]
[8] He, Y., Cao, B. and Huang, Y. (2024) Effect of Endometriosis on Prognosis of Ovarian Clear Cell Carcinoma: A 10-Year Retrospective Study. Frontiers in Oncology, 14, Article ID: 1438309. [Google Scholar] [CrossRef] [PubMed]
[9] Hermens, M., van Altena, A.M., Nieboer, T.E., Schoot, B.C., van Vliet, H.A.A.M., Siebers, A.G., et al. (2020) Incidence of Endometrioid and Clear-Cell Ovarian Cancer in Histological Proven Endometriosis: The ENOCA Population-Based Cohort Study. American Journal of Obstetrics and Gynecology, 223, 107.e1-107.e11. [Google Scholar] [CrossRef] [PubMed]
[10] Koninckx, P.R., Ussia, A., Adamyan, L., Wattiez, A., Gomel, V. and Martin, D.C. (2019) Pathogenesis of Endometriosis: The Genetic/Epigenetic Theory. Fertility and Sterility, 111, 327-340. [Google Scholar] [CrossRef] [PubMed]
[11] World Health Organization (2023) Endometriosis. World Health Organization.
[12] Nap, A.W., Groothuis, P.G., Demir, A.Y., Evers, J.L.H. and Dunselman, G.A.J. (2004) Pathogenesis of Endometriosis. Best Practice & Research Clinical Obstetrics & Gynaecology, 18, 233-244. [Google Scholar] [CrossRef] [PubMed]
[13] 张娜. 子宫内膜异位症的病因学研究进展[J]. 实用临床医学, 2016, 17(1): 104-106.
[14] Halme, J., Hammond, M.G., Hulka, J.F., et al. (1984) Retrograde Menstruation in Healthy Women and in Patients with Endometriosis. Obstetrics & Gynecology, 64, 151-154.
[15] Jabr, F.I. and Mani, V. (2014) An Unusual Cause of Abdominal Pain in a Male Patient: Endometriosis. Avicenna Journal of Medicine, 4, 99-101. [Google Scholar] [CrossRef] [PubMed]
[16] 仝佳丽, 郎景和. 子宫内膜异位症的在位内膜病变研究进展[J]. 现代妇产科进展, 2010, 19(6): 465-467.
[17] 郎景和. 关于子宫内膜异位症的再认识及其意义[J]. 中国工程科学, 2009, 11(10): 137-142.
[18] Becker, C.M., Bokor, A., Heikinheimo, O., et al. (2022) ESHRE Guideline: Endometriosis. Human Reproduction Open, 2022, hoac009.
[19] Gargett, C.E., Nguyen, H.P.T. and Ye, L. (2012) Endometrial Regeneration and Endometrial Stem/Progenitor Cells. Reviews in Endocrine and Metabolic Disorders, 13, 235-251. [Google Scholar] [CrossRef] [PubMed]
[20] Maruyama, T. and Yoshimura, Y. (2012) Stem Cell Theory for the Pathogenesis of Endometriosis. Frontiers in Bioscience, 4, 2754-2763. [Google Scholar] [CrossRef] [PubMed]
[21] Chen, S., Liu, Y., Zhong, Z., Wei, C., Liu, Y. and Zhu, X. (2023) Peritoneal Immune Microenvironment of Endometriosis: Role and Therapeutic Perspectives. Frontiers in Immunology, 14, Article ID: 1134663. [Google Scholar] [CrossRef] [PubMed]
[22] Chan, R.W.S., Schwab, K.E. and Gargett, C.E. (2004) Clonogenicity of Human Endometrial Epithelial and Stromal Cells1. Biology of Reproduction, 70, 1738-1750. [Google Scholar] [CrossRef] [PubMed]
[23] Gargett, C.E. (2007) Stem Cells in Human Reproduction. Reproductive Sciences, 14, 405-424. [Google Scholar] [CrossRef] [PubMed]
[24] Maruyama, T. (2022) A Revised Stem Cell Theory for the Pathogenesis of Endometriosis. Journal of Personalized Medicine, 12, Article 216. [Google Scholar] [CrossRef] [PubMed]
[25] Feng, Y., Zhan, F., Zhong, Y. and Tan, B. (2020) Effects of Human Umbilical Cord Mesenchymal Stem Cells Derived from Exosomes on Migration Ability of Endometrial Glandular Epithelial Cells. Molecular Medicine Reports, 22, 715-722. [Google Scholar] [CrossRef] [PubMed]
[26] Cousins, F.L., Pandoy, R., Jin, S. and Gargett, C.E. (2021) The Elusive Endometrial Epithelial Stem/Progenitor Cells. Frontiers in Cell and Developmental Biology, 9, Article ID: 640319. [Google Scholar] [CrossRef] [PubMed]
[27] 王姝, 郎景和. 子宫内膜异位症——一种干细胞疾病? [J]. 现代妇产科进展, 2008, 18(10): 721-724.
[28] Liu, Y., Liang, S., Yang, F., Sun, Y., Niu, L., Ren, Y., et al. (2020) Biological Characteristics of Endometriotic Mesenchymal Stem Cells Isolated from Ectopic Lesions of Patients with Endometriosis. Stem Cell Research & Therapy, 11, Article No. 346. [Google Scholar] [CrossRef] [PubMed]
[29] Praetorius, T.H., Leonova, A., Lac, V., Senz, J., Tessier-Cloutier, B., Nazeran, T.M., et al. (2022) Molecular Analysis Suggests Oligoclonality and Metastasis of Endometriosis Lesions across Anatomically Defined Subtypes. Fertility and Sterility, 118, 524-534. [Google Scholar] [CrossRef] [PubMed]
[30] Liu, S., Li, X., Gu, Z., Wu, J., Jia, S., Shi, J., et al. (2025) Single-Cell and Spatial Transcriptomic Profiling Revealed Niche Interactions Sustaining Growth of Endometriotic Lesions. Cell Genomics, 5, Article 100737. [Google Scholar] [CrossRef] [PubMed]
[31] Chan, R.W.S., Ng, E.H.Y. and Yeung, W.S.B. (2011) Identification of Cells with Colony-Forming Activity, Self-Renewal Capacity, and Multipotency in Ovarian Endometriosis. The American Journal of Pathology, 178, 2832-2844. [Google Scholar] [CrossRef] [PubMed]
[32] Gargett, C.E., Schwab, K.E. and Deane, J.A. (2015) Endometrial Stem/Progenitor Cells: The First 10 Years. Human Reproduction Update, 22, 137-163. [Google Scholar] [CrossRef] [PubMed]
[33] Shifon, S., Tyrinova, T., Veretelnikova, T., Pasman, N. and Chernykh, E. (2025) Endometriosis as an Immune-Mediated Disease: Pathogenetic Mechanisms and Therapeutic Strategies. Frontiers in Immunology, 16, Article ID: 1727183. [Google Scholar] [CrossRef
[34] Saunders, P.T.K. and Horne, A.W. (2021) Endometriosis: Etiology, Pathobiology, and Therapeutic Prospects. Cell, 184, 2807-2824. [Google Scholar] [CrossRef] [PubMed]
[35] Ducreux, B., Patrat, C., Firmin, J., Ferreux, L., Chapron, C., Marcellin, L., et al. (2025) Systematic Review on the DNA Methylation Role in Endometriosis: Current Evidence and Perspectives. Clinical Epigenetics, 17, Article No. 35. [Google Scholar] [CrossRef] [PubMed]
[36] Pittenger, M.F., Mackay, A.M., Beck, S.C., Jaiswal, R.K., Douglas, R., Mosca, J.D., et al. (1999) Multilineage Potential of Adult Human Mesenchymal Stem Cells. Science, 284, 143-147. [Google Scholar] [CrossRef] [PubMed]
[37] Du, H. and Taylor, H.S. (2007) Contribution of Bone Marrow-Derived Stem Cells to Endometrium and Endometriosis. Stem Cells, 25, 2082-2086. [Google Scholar] [CrossRef] [PubMed]
[38] Shi, Q., Gao, J., Jiang, Y., Sun, B., Lu, W., Su, M., et al. (2017) Differentiation of Human Umbilical Cord Wharton’s Jelly-Derived Mesenchymal Stem Cells into Endometrial Cells. Stem Cell Research & Therapy, 8, Article No. 246. [Google Scholar] [CrossRef] [PubMed]
[39] Hirakawa, T., Yotsumoto, F., Shirasu, N., Kiyoshima, C., Urushiyama, D., Yoshikawa, K., et al. (2022) Trophic and Immunomodulatory Effects of Adipose Tissue Derived Stem Cells in a Preclinical Murine Model of Endometriosis. Scientific Reports, 12, Article No. 8031. [Google Scholar] [CrossRef] [PubMed]
[40] Zolbin, M.M., Mamillapalli, R., Nematian, S.E., Goetz, T.G. and Taylor, H.S. (2019) Adipocyte Alterations in Endometriosis: Reduced Numbers of Stem Cells and MicroRNA Induced Alterations in Adipocyte Metabolic Gene Expression. Reproductive Biology and Endocrinology, 17, Article No. 36. [Google Scholar] [CrossRef] [PubMed]
[41] Simancas-Racines, D., Jiménez-Flores, E., Montalvan, M., Horowitz, R., Araujo, V. and Reytor-González, C. (2026) Endometriosis as a Systemic and Complex Disease: Toward Phenotype-Based Classification and Personalized Therapy. International Journal of Molecular Sciences, 27, Article 908. [Google Scholar] [CrossRef
[42] Konrad, L., Dietze, R., Riaz, M.A., Scheiner-Bobis, G., Behnke, J., Horné, F., et al. (2020) Epithelial-Mesenchymal Transition in Endometriosis—When Does It Happen? Journal of Clinical Medicine, 9, Article 1915. [Google Scholar] [CrossRef] [PubMed]
[43] Vissers, G., Giacomozzi, M., Verdurmen, W., Peek, R. and Nap, A. (2024) The Role of Fibrosis in Endometriosis: A Systematic Review. Human Reproduction Update, 30, 706-750. [Google Scholar] [CrossRef] [PubMed]
[44] Rahmioglu, N., Mortlock, S., Ghiasi, M., Møller, P.L., Stefansdottir, L., Galarneau, G., et al. (2023) The Genetic Basis of Endometriosis and Comorbidity with Other Pain and Inflammatory Conditions. Nature Genetics, 55, 423-436. [Google Scholar] [CrossRef] [PubMed]
[45] Rodda, D.J., Chew, J., Lim, L., Loh, Y., Wang, B., Ng, H., et al. (2005) Transcriptional Regulation of Nanog by OCT4 and Sox2. Journal of Biological Chemistry, 280, 24731-24737. [Google Scholar] [CrossRef] [PubMed]
[46] Mukherjee, S., Luedeke, D.M., McCoy, L., Iwafuchi, M. and Zorn, A.M. (2022) SOX Transcription Factors Direct TCF-Independent Wnt/β-Catenin Responsive Transcription to Govern Cell Fate in Human Pluripotent Stem Cells. Cell Reports, 40, Article 111247. [Google Scholar] [CrossRef] [PubMed]
[47] Götte, M., Wolf, M., Staebler, A., Buchweitz, O., Kiesel, L. and Schüring, A.N. (2011) Aberrant Expression of the Pluripotency Marker SOX-2 in Endometriosis. Fertility and Sterility, 95, 338-341. [Google Scholar] [CrossRef] [PubMed]
[48] 蒋振, 颜丽萍, 彭芬, 等. SOX2、HMGB1在子宫内膜异位症患者异位组织中的表达及临床意义[J]. 中国性科学, 2022, 31(1): 51-55.
[49] Burney, R.O. and Giudice, L.C. (2012) Pathogenesis and Pathophysiology of Endometriosis. Fertility and Sterility, 98, 511-519. [Google Scholar] [CrossRef] [PubMed]
[50] Attar, E., Tokunaga, H., Imir, G., Yilmaz, M.B., Redwine, D., Putman, M., et al. (2009) Prostaglandin E2 via Steroidogenic Factor-1 Coordinately Regulates Transcription of Steroidogenic Genes Necessary for Estrogen Synthesis in Endometriosis. The Journal of Clinical Endocrinology & Metabolism, 94, 623-631. [Google Scholar] [CrossRef] [PubMed]
[51] Bulun, S.E., Yang, S., Fang, Z., Gurates, B., Tamura, M., Zhou, J., et al. (2001) Role of Aromatase in Endometrial Disease. The Journal of Steroid Biochemistry and Molecular Biology, 79, 19-25. [Google Scholar] [CrossRef] [PubMed]
[52] Parpex, G., Nicco, C., Chassaing, B., Santulli, P., Chouzenoux, S., Bourdon, M., et al. (2025) Microbiota Insights in Endometriosis. Microbiome, 13, Article No. 251. [Google Scholar] [CrossRef
[53] Khan, K.N., Kitajima, M., Fujishita, A., Nakashima, M. and Masuzaki, H. (2013) Toll‐Like Receptor System and Endometriosis. Journal of Obstetrics and Gynaecology Research, 39, 1281-1292. [Google Scholar] [CrossRef] [PubMed]
[54] Lin, H., Xiong, W., Fu, L., Yi, J. and Yang, J. (2025) Damage-Associated Molecular Patterns (Damps) in Diseases: Implications for Therapy. Molecular Biomedicine, 6, Article No. 60. [Google Scholar] [CrossRef
[55] Su, W., Cui, H., Wu, D., Yu, J., Ma, L., Zhang, X., et al. (2021) Suppression of TLR4-MyD88 Signaling Pathway Attenuated Chronic Mechanical Pain in a Rat Model of Endometriosis. Journal of Neuroinflammation, 18, Article No. 65. [Google Scholar] [CrossRef] [PubMed]
[56] 张紫薇, 王艳. JAK2/STAT3信号通路与子宫内膜异位症的相关性[J]. 中国生育健康杂志, 2016, 27(6): 599-601.
[57] Widera, D., Mikenberg, I., Elvers, M., Kaltschmidt, C. and Kaltschmidt, B. (2006) Tumor Necrosis Factor Α Triggers Proliferation of Adult Neural Stem Cells via IKK/NF-κB Signaling. BMC Neuroscience, 7, Article No. 64. [Google Scholar] [CrossRef] [PubMed]
[58] Xu, X., Li, J., Lin, H., Lin, Z. and Ji, G. (2025) The Role of TGF-β Superfamily in Endometriosis: A Systematic Review. Frontiers in Immunology, 16, Article ID: 1638604. [Google Scholar] [CrossRef
[59] Feng, Y., Dong, H. and Tan, B. (2023) Endometriotic Mesenchymal Stem Cells Promote the Fibrosis Process of Endometriosis through Paracrine TGF‐β1 Mediated rasal1 Inhibition. Journal of Obstetrics and Gynaecology Research, 50, 467-477. [Google Scholar] [CrossRef] [PubMed]
[60] Chang, C., Lin, Y., Tyan, Y., Chiu, Y., Liang, Y., Chen, C., et al. (2021) Interleukin-1β-Induced Matrix Metalloproteinase-3 via ERK1/2 Pathway to Promote Mesenchymal Stem Cell Migration. PLOS ONE, 16, e0252163. [Google Scholar] [CrossRef] [PubMed]
[61] Shokri, M., Bozorgmehr, M., Ghanavatinejad, A., Falak, R., Aleahmad, M., Kazemnejad, S., et al. (2019) Human Menstrual Blood-Derived Stromal/Stem Cells Modulate Functional Features of Natural Killer Cells. Scientific Reports, 9, Article No. 10007. [Google Scholar] [CrossRef] [PubMed]
[62] Aleahmad, M., Bozorgmehr, M., Nikoo, S., Ghanavatinejad, A., Shokri, M., Montazeri, S., et al. (2021) Endometrial Mesenchymal Stem/Stromal Cells: The Enigma to Code Messages for Generation of Functionally Active Regulatory T Cells. Stem Cell Research & Therapy, 12, Article No. 536. [Google Scholar] [CrossRef] [PubMed]
[63] Park, M., Kim, Y.S. and Song, H. (2025) Macrophages: A Double-Edged Sword in Female Reproduction and Disorders. Experimental & Molecular Medicine, 57, 285-297. [Google Scholar] [CrossRef] [PubMed]
[64] Zhang, H., Dai, Z., Wu, W., Wang, Z., Zhang, N., Zhang, L., et al. (2021) Regulatory Mechanisms of Immune Checkpoints PD-L1 and CTLA-4 in Cancer. Journal of Experimental & Clinical Cancer Research, 40, Article No. 184. [Google Scholar] [CrossRef] [PubMed]