A Study On Evaluate The Relationship Between Number Of Nerve Fibers In Tissues Of Endometriosis And Pain

Objective:1. To investigate the correlation of the distribution of myelinated and unmyelinated nerve fibers in the endometriotic tissues with endometriosis-associated pain.2. To observe the influence of using GnRHa drugs pre-operatively on distribution of nerve fibers in endometriotic lesions.3. To explore the role of nerve fibers distribution in eutopic endometrial basal lamina and functional layer in the pathogenesis of endometriosis-associated pain.Methods:1. Immunohistochemical method detects the distribution of different nerve fibers in different endometriotic tissues,including peritoneal endometriotic lesions,ovarian endometriotic cyst wall,endometriotic nodule of uterosacral ligament as well as the normal peritoneum,ovarian mature cystic teratoma wall,normal uterosacral ligament.Analyze the difference in nerve numbers in various endometriotic tissues and its correlation with pain and clinical stage.2. Immunohistochemical method to compare the distribution of myelinated and unmyelinated nerve fibers in eutopic endometrium between endometriosis and non-endometriosis patients.Observe the number of nerve fibers distribution and its difference in between endometrial basal lamina and functional layer.Results:1. The number of unmyelinated nerve fibers in peritoneal endometriotic lesions and uterosacral ligament lesions were significantly higher than that in the normal peritoneum(P=0.001) and uterosacral ligament (P=0.000) respectively, whereas there were no significant difference of the number of myelinated nerve fibers between them(P=0.277 and 0.647 respectively).Expression of myelinated and unmyelinated nerve fibers in the ovarian endometriosis cyst walls was absent or only a small amount which showed no significant difference in comparing with the control(P=0.473 and 0.634).2. There were significant differences in the numbers of unmyelinated nerve fibers between different endometriotic tissues:the number of unmyelinated nerve fibers in endometriotic lesions of uterosacral ligament (29.43±13.52/mm 2) was significantly higher than the peritoneal endometriotic lesion and the wall of ovarian endometriosis cyst (7.62±4.20/mm 2 and 0.73±1.29/mm2);There was also significant difference between the number of nerve fibers of peritoneal endometriosis and ovarian endometriosis cyst wall. However, there was no significant intergroup difference in number of myelinated nerve fibers labeled by NF. 3. The number of the unmyelinated nerve fibers of different endometriotic tissues was not significantly correlated to the clinical stage. There was a low correlation between the number of unmyelinated nerve fibers in peritonaeum endometriosis lesions and the degree of dysmenorrhea, anus bearing-down pain, sexual intercourse pain and chronic pelvic pain.Number of the unmyelinated nerve fibers in ovary endometriosis cyst wall was not noticeable correlated with dysmenorrhea, anus bearing-down pain and sexual intercourse pain, however, it was a moderate correlation with the degree of chronic pelvic pain. The number of unmyelinated nerve fibers in endometriotic nodule of uterosacral ligament was significantly associated with the dysmenorrhea, sexual intercourse pain and anus bearing-down pain, but it showed low correlation with the chronic pelvic pain. After the application of GnRHa drugs, the number of nerve fibers in endometriotic tissues was significantly decreased comparing to non-GnRHa group.4. The expression of unmyelinated nerve fibers in endometriotic eutopic endometrium was significantly lower than ectopic lesions in endometriosis patients, but it was significantly higher than non-endometriosis patients.5. The marker of nerve fibers, PGP9.5, expressed in both the functional layer and basal lamina of the endometrium in the patients with endometriosis, but it was not expressed in the functional layer and are absent or only a small amount in the basal layer of the normal endometrium.Conclusions:1. The distribution of unmyelinated nerve fibers in different endometriotic tissues was significantly increased which had different degree on the correlations with varieties of pain and not correlated to the clinical stage. The mechanisms of neuroanatomy explained the relationships between endometriosis-associated pain and the distribution of nerve fibers.2. The myelinated and unmyelinated nerve fibers expression was significantly higher in the eutopic endometrial basal lamina in patients with endometriosis than the normal basal lamina of endometrium. There were remarkable resemblance between the expression of the myelinated and unmyelinated nerve fibers in the basal lamina of eutopic endometrium and the endometriotic lesions of the endometriosis patients. This further confirmed the "endometrial stem cell theory", that is to say, the biological quality of ectopic endometrium was depended on the different characters in development of the basal lamina into functional layer.3. The nerve fibres marker, PGP9.5, was so strikingly expressed in the functional layer of eutopic endometrium of all women with endometriosis whereas it was not in the functional layer of nomal endometrium. We believe, in the future, PGP9.5 may be a relatively simple biomarker for the diagnosis of endometriosis using endometrial biopsies, and it may help to explore a new method for early diagnosis of endometriosis.