子宫内膜异位症疼痛的机制

doi:10.6040/j.issn.1671-7554.0.2024.0943

摘要/Abstract

摘要： 子宫内膜异位症(内异症)是一种常见于生育年龄女性的慢性炎症性疾病,累及多器官系统且为雌激素依赖性疾病。70%~80%的患者以疼痛为主要症状,根据病灶累及部位,疼痛分别表现为痛经、性交痛、排尿排便痛、非经期慢性盆腔疼痛等。内异症疼痛的机制错综复杂且涉及多条交互作用的路径,一直是研究的热点。目前主要认为下丘脑-垂体-性腺轴、自身免疫炎症系统、外周/中枢神经系统这三大系统的交互作用,导致疼痛持续加剧及痛觉过敏。下丘脑-垂体-性腺轴释放雌激素促进内异症病灶生长,刺激外周伤害性感受器激活感觉神经纤维,进而触发自身免疫系统的巨噬细胞及肥大细胞等分泌炎症因子及致痛因子,最终导致周围神经及中枢神经系统敏化,神经系统激活后正反馈释放P物质、降钙素基因相关肽等因子持续激活免疫系统,导致持续敏化及交叉敏化,疼痛加剧。

关键词: 子宫内膜异位症, 疼痛, 雌激素, 炎症因子, 外周敏化, 中枢神经敏化

Abstract: Endometriosis is a chronic inflammatory disease commonly found in women of reproductive age, affecting multiple organ systems and being estrogen dependent. About 70%-80% of the patients present with pain as the main symptom. Depending on the location of the lesion, the pain is manifested as dysmenorrhea, dyspareunia, dysphasia, non-menstrual chronic pelvic pain, and so on. The mechanism of pain in endometriosis is complex and involves multiple interactive pathways, which has always been a research hotspot. Currently, the interaction between the hypothalamic-pituitary-gonadal axis, the autoimmune inflammatory system, and the peripheral/central nervous system is mainly considered, leading to sustained exacerbation of pain and hyperalgesia. Firstly, the hypothalamic-pituitary-gonadal axis releases estrogen to promote the growth of endometriosis lesions, which stimulates peripheral nociceptors to activate sensory nerve fibers. Then, the lesion triggers the secretion of inflammatory and pain inducing factors by macrophages and mast cells in the autoimmune system, leading to sensitization of the peripheral and central nervous systems. Finally, after activation of the nervous system, it releases factors such as substance P and calcitonin gene-related peptide to continuously activate the immune system, resulting in sustained sensitization, cross sensitization and increased pain.

Key words: Endometriosis, Pain, Estrogen, Inflammatory factors, Peripheral sensitization, Central nervous system sensitization

中图分类号:

R711.71

徐萍,张信美. 子宫内膜异位症疼痛的机制[J]. 山东大学学报 (医学版), 2025, 63(10): 1-7.

XU Ping, ZHANG Xinmei. Mechanisms of pain in endometriosis[J]. Journal of Shandong University (Health Sciences), 2025, 63(10): 1-7.

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