Expression Of Nerve Fibers In The Eutopic Endometrium In Endometriosis

Background and ObjectiveEndometriosis is a disease that the endometrium with activity grows outside the uterine cavity. Endometriosis is frequently-occurring and common disease of women at reproductive age,in recent years,the incidence is rising, approximately 5-15% Women were found with endometriosis in gynecologic surgery.Endometriosis lesions are widely distributed,which can affect multiple internal and external pelvic organs and cause different clinical symptoms,such as dysmenorrhea, chronic pelvic pain,menstrual abnormalities, infertility,pelvic mass and so on,seriously affect the quality of life of patients.Etiology research in the endometriosis field is a hot spot,in spite of the researches have been done by domestic and foreign scholars for many years,the mechanism of the disease is not fully clear.The leading theories include Sampson's retrograde menstruation theory,metaplasia of coelomic epithelium and the induction theory.In recent years,the eutopic endometrium is affirmed to play an important role.Researches of the tissue pathology,biochemistry,molecular biology,genetics and other aspects about eutopic endometrium show it play a decisive role in the occurrence and development of Endometriosis.Eutopic endometrium between endometriosis and non-endometriosis patients exists essential differences,which is the basic cause in the development of endometriosis.Anaf described that there were nerve fibers in rectovaginal endometriotic nodules foci in 2000 ,Karen JB pointed that nerve fibers domination is one of the pain mechanisms of endometriosis in 2005 on SCIENCE magazine.Many scholars later confirmed the presence of nerve fibers in endometriosis lesions and eutopic endometrial tissues. In this study,we detected nerve fiber density in eutopic endometrium by immunohistochemistry,also observed the spatial relations between endometrial glands and nerve fibers,further study the correlationship between clinical stage of endometriosis and not only nerve fiber density but also the nearest distance between nerve fibers and endometrial glands,we expect to explain the occurrence and development of endometriosis through nerve fibers in eutopic endometrial,and guide the treatment of endometriosis and the follow-up.Materials and methods1. Samples64 patients diagnosed with endometriosis by surgery (laparoscopic or open surgery)and pathological confirmation from January 2008 to December 2009 in Guangzhou Red Cross Hospital were divided into four groups according to the revised American Fertility Society classification(rAFS):stageⅠ,11cases(group 1);stageⅡ,12 cases(group 2);stage III,20 cases(group 3);stageⅣ,21 cases(group 4),and 10 patients diagnosed without endometriosis but with Uterine fibroids served as the control group(group 0).All patients accepted the diagnostic curettage before the laparoscopic operation or laparotomy(pathological results showed that 47 persons had proliferative endometrium,27 persons had secretory phase endometrium).All cases had no history of endocrine disease, gynecological malignancy,genital tract inflammation,and they didn't receive preoperative hormone treatment or surgical operation within 3 months.2. Experimental MethodsThe specimens of each group were embedded in paraffin wax and each section was cut routinely,then we carried on the immunohistochemistry test,using antibodies of polyclonal mouse anti-human S-100,polyclonal rabbit anti-human GAP-43 protein to mark nerve fibers,calculating nerve fiber density,measuring the most nearest distance between the nerve fibers and endometrial glands with endometriosis.3. Statistical MethodsSPSS 16.0 software was used for statistical analysis.Nerve fiber density and the most nearest distance between the nerve fibers and endometrial glands were compared using the Kruskal-Wallis test because their results were Skewed distribution. Nerve fiber density in different phase of the menstrual cycle were compared using Mann-Whitney test.Differences were considered to be significant at P<0.05.Results1. Nerve fibers exist in eutopic endometrium either non-endometriosis or endometriosis. The density of nerve fibers with non-endometriosis was significantly lower than that with endometriosis. The nerve fiber density of each group with endometriosis was significantly different.(both GAP-43 groups and S-100 groups P <0.001).Nerve fiber density in different phase of the menstrual cycle had no difference (both GAP-43 groups and S-100 groups P>0.05);2. Comparison of the most nearest distance between the nerve fibers and endometrial glands with endometriosis demonstrated no significant differences (both GAP-43 groups and S-100 groups P>0.05).Conclusions1. Nerve fibers exist in eutopic endometrium with endometriosis, Contrast those persons with non-endometriosis,the difference of density was statistically significant;the difference of density of each group with endometriosis was statistically significant.Nerve fibers play an important role in occurrence and development with endometriosis.2. Comparison the differences of the most nearest distance between the nerve fibers and endometrial glands with endometriosis demonstrated is meaningless in statistics, demonstrating progression of endometriosis doesn't relate to the most nearest distance between the nerve fibers and endometrial glands.