Abstract：
Adenomyosis is associated with dysmenorrhea and chronic pelvic pain; however, the triggering mechanisms of painful stimuli and the role of uterine nerve fibers in the manifestation of pain remain poorly understood. The objective of this study was to systematically review the role of uterine nerve fibers\' presence and density in the occurrence of pain in patients with adenomyosis. An electronic search was performed using the Embase, PubMed/Medline, and Cochrane databases. We included all studies from inception to November 2023. A total of ten studies that compared uterine biopsies samples of women with and without adenomyosis were included. The biomarker antiprotein gene product 9.5 was decreased or absent in the endometrium of most included women with adenomyosis. None of the included studies observed a difference in neurofilament (NF) staining between the adenomyosis and non-adenomyosis groups. Studies that assessed nerve growth factor (NGF) staining were heterogeneous in design. One study reported no difference in immunohistochemistry staining in any endometrial layer between the adenomyosis and non-adenomyosis groups, while another reported increased staining in the adenomyosis functional endometrial layer, and a third study reported overexpression of NGF, synaptophysin (SYN), and microtubule-associated protein 2 mRNA in focal adenomyosis alone. Preliminary data from poor-quality studies suggest an increase in the uterine density of nerve fibers in patients with adenomyosis. Well-designed studies are essential to assess the cause-and-effect relationship between uterine nerve fibers and pain in patients with adenomyosis.
摘要：
子宫腺肌病与痛经和慢性盆腔疼痛有关;然而，疼痛刺激的触发机制和子宫神经纤维在疼痛表现中的作用仍然知之甚少。本研究的目的是系统评价子宫腺肌病患者子宫神经纤维的存在和密度在疼痛发生中的作用。使用Embase进行了电子搜索，PubMed/Medline,和Cochrane数据库。我们包括了从开始到2023年11月的所有研究。共纳入了十项研究，这些研究比较了有和没有子宫腺肌病的女性的子宫活检样本。在大多数患有子宫腺肌病的妇女的子宫内膜中，生物标志物抗蛋白基因产物9.5减少或缺失。所包括的研究均未观察到子宫腺肌病与非子宫腺肌病组之间的神经丝（NF）染色差异。评估神经生长因子(NGF)染色的研究在设计上是异质的。一项研究报道，子宫腺肌病和非子宫腺肌病组的任何子宫内膜层的免疫组织化学染色均无差异，而另一个报道在子宫腺肌病功能子宫内膜层染色增加，第三项研究报道了NGF的过度表达，突触素（SYN），和微管相关蛋白2mRNA在单纯局灶性子宫腺肌病中的作用。低质量研究的初步数据表明，子宫腺肌病患者的神经纤维子宫密度增加。精心设计的研究对于评估子宫腺肌病患者子宫神经纤维与疼痛之间的因果关系至关重要。
