Objective: To investigate degrees of fibrosis of adenomyosis (AM) myometrium and explore its relationship with dysmenorrhea. Methods: Thirty AM patients who had hysterectomy from July, 2015 to December, 2016 in Beijing Obstetrics and Gynecology Hospital were selected as AM group; 28 cases of hysterectomy due to cervical lesions (none AM) were selected as control group. The area ratio of collagen fiber in the two groups was analysed by modified Masson stain, and the expression of collagen type Ⅰprotein in the two groups was analysed by immunohistochemical method. Results: (1) The degree of fibrosis:the area ratio of collagen fiber and the expression of collagen type Ⅰof AM group [(34.5±5.1)%, 0.23±0.06] were significantly higher than those of control group [(26.7±10.1)%,0.18±0.08; all P<0.05]. (2) The relationship between the degree of fibrosis and dysmenorrhea: the area ratio of collagen fiber and the expression of collagen type Ⅰ in severe dysmenorrhea, moderate dysmenorrhea, and none-mild dysmenorrhea were (35.3±4.3) %, 0.25±0.05; (35.7±3.2) %, 0.26±0.06; (25.0±2.9) %, 0.15±0.03, there were significantly different among them (all P<0.01) . And the area ratio of collagen fiber, the expression of collagen typeⅠwere positively correlated with the degree of dysmenorrhea (r=0.50, 0.50; all P<0.05) . Conclusions: The area ratio of collagen fiber and the expression of collagen type Ⅰ in AM are higher than in control group, and positively correlated with the severity of dysmenorrhea. These results suggest the degrees of fibrosis might be correlated with dysmenorrhea.
目的： 探讨子宫腺肌病子宫肌层纤维化程度与痛经的相关性。 方法： 选取2015年7月至2016年12月于首都医科大学附属北京妇产医院，因子宫腺肌病行子宫切除术的患者30例作为子宫腺肌病组，选择同期因子宫颈上皮内瘤变Ⅲ级行子宫切除术的患者28例作为对照组，收集两组患者术前痛经的视觉模拟评分法（VAS）评分，采用改良Masson染色法和免疫组化二步法分别检测两组患者子宫肌层中的胶原纤维面积比率和Ⅰ型胶原蛋白的表达水平。 结果： （1）纤维化程度分析：胶原纤维面积比率及Ⅰ型胶原蛋白的表达水平在子宫腺肌病组患者肌层中分别为（34.5±5.1）%、0.23±0.06，高于对照组[分别为（26.7±10.1）%、0.18±0.08]，分别比较，差异均有统计学意义（P均<0.05）。（2）纤维化程度与痛经的相关性：胶原纤维面积比率及Ⅰ型胶原蛋白的表达水平在子宫腺肌病组中的重度痛经、中度痛经、无~轻度痛经患者分别为（35.3±4.3）%、0.25±0.05，（35.7±3.2）%、0.26±0.06，（25.0±2.9）%、0.15±0.03，无~轻度痛经者与中度痛经者、重度痛经者之间均有差异（P均<0.01）；且胶原纤维面积比率及Ⅰ型胶原蛋白表达水平与痛经程度均呈正相关，相关系数分别为r胶原纤维面积=0.50、rⅠ型胶原蛋白=0.50（P均<0.05）。 结论： 子宫腺肌病子宫肌层发生了明显纤维化，胶原纤维面积比率及Ⅰ型胶原蛋白表达均高于正常，且与痛经VAS评分呈正相关；子宫腺肌病患者痛经的发生可能与肌层纤维化形成有关。.
Keywords: Adenomyosis; Collagen type Ⅰ; Dysmenorrhea; Fibrosis.