腹腔镜手术及GnRH-a治疗子宫内膜异位症对患者T淋巴细胞及其相关细胞因子的影响

孙晓辉

【摘要】 目的：探討腹腔镜手术及GnRH-a治疗子宫内膜异位症对患者T淋巴细胞及其相关细胞因子的影响。方法：选取2019年1月-2020年12月在本院接受腹腔镜手术治疗的65例子宫内膜异位症患者，其中35例单纯手术治疗的患者作为手术组，30例手术联合GnRH-a治疗的患者作为联合组，另选取同期于本院行腹腔镜手术的25例单纯输卵管阻塞患者作为对照组。比较三组术前辅助性T淋巴细胞17（Th17）、调节性T淋巴细胞（Treg）、Th17/Treg及IL-10、IL-17、IL-22、IL-23、TGF-β水平;比较手术组与联合组术前与术后1、3个月的Th17、Treg、Th17/Treg及IL-10、IL-17、IL-22、IL-23、TGF-β水平。结果：手术组及联合组术前Th17、Th17/Treg、IL-17、IL-22、IL-23均高于对照组，Treg、IL-10、TGF-β均低于对照组（P<0.05）;手术组与联合组术前上述各指标比较，差异均无统计学意义（P>0.05）。术后1、3个月，手术组与联合组Th17、Th17/Treg、IL-17、IL-22、IL-23均低于术前，Treg、IL-10、TGF-β均高于术前（P<0.05），但两组间上述各指标比较，差异均无统计学意义（P>0.05）。术后3个月，手术组及联合组Th17、IL-17、IL-22、IL-23均低于术后1个月，Treg、IL-10、TGF-β均高于术后1个月，手术组Th17/Treg低于术后1个月（P<0.05）。结论：子宫内膜异位症患者存在免疫失衡，腹腔镜手术可改善Th17、Treg及相关细胞因子水平，未观察到GnRH-a对其有明显影响。

【关键词】 子宫内膜异位症 辅助性T淋巴细胞17 调节性T淋巴细胞 细胞因子 腹腔镜手术 GnRH-a

[Abstract] Objective： To investigate the effects of laparoscopic surgery and GnRH-a on T lymphocytes and related cytokines in patients with endometriosis. Method： From January 2019 to December 2020， 65 patients with endometriosis who underwent laparoscopic surgery in our hospital were selected， among which 35 patients with simple surgery as the operation group， 30 patients with surgery combined with GnRH-a as the combination group， and 25 patients with simple fallopian tube obstruction who underwent laparoscopic surgery in our hospital at the same period as the control group. The preoperative levels of helper T lymphocytes 17 （Th17）， regulatory T lymphocytes （Treg）， Th17/Treg， IL-10， IL-17， IL-22， IL-23 and TGF-β in the three groups were compared. The levels of Th17， Treg， Th17/Treg， IL-10， IL-17， IL-22， IL-23 and TGF-β before surgery and 1， 3 months after surgery were compared between the operation group and the combined group. Result： Before surgery， Th17， Th17/Treg， IL-17， IL-22 and IL-23 in the operation group and the combined group were all higher than those in the control group， while Treg， IL-10 and TGF-β were all lower than those in the control group （P<0.05）; There were no statistical significance in the above indexes between the operation group and the combined group （P>0.05）. 1 and 3 months after surgery， Th17， Th17/Treg， IL-17， IL-22 and IL-23 in the operation group and the combined group were all lower than those before surgery， while Treg， IL-10 and TGF-β were all higher than those before surgery （P<0.05）， but there were no statistical significance in the above indexes between the two groups （P>0.05）. 3 months after surgery， Th17， IL-17， IL-22 and IL-23 in the operation group and the combined group were all lower than those at 1 month after surgery; Treg， IL-10 and TGF-β were all higher than those at 1 month after surgery; Th17/Treg in the operation group was lower than that at 1 month after surgery （P<0.05）. Conclusion： There is immune imbalance in patients with endometriosis. Laparoscopic surgery can improve the levels of Th17， Treg and cytokines， but there is no significant effect of GnRH-a on them.

[Key words] Endometriosis Helper T lymphocyte 17 Regulatory T lymphocytes Cytokines Laparoscopic surgery GnRH-a

First-author’s address： Haicheng Central Hospital， Haicheng 114200， China

doi：10.3969/j.issn.1674-4985.2021.25.009

6%～10%的育龄期妇女受到子宫内膜异位症影响并引起严重的问题，如盆腔疼痛，痛经和不孕不育[1]。虽然子宫内膜异位症是妇科研究最多的疾病之一，但其发病机制尚不完全清楚，目前以Sampson的经血逆流种植学说为主导理论[2]。近年来，许多研究揭示了子宫内膜异位症的炎症性质，在子宫内膜异位症患者的体液中检测到许多免疫细胞及其分泌产物细胞因子和趋化因子[1，3-4]。……