子宫结合带的结构和功能与子宫内膜异位性疾病的关系
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摘要
子宫结合带(JZ)是1983年由Hricak等提出,把磁共振成像(MRI)上肌层和内膜之间的低信号带称之为子宫结合带,随后JZ在组织解剖上获得了定位,即子宫肌层的最内层。已经证实JZ功能异常与子宫肌瘤、子宫腺肌症、子宫内膜异位症等的发生密切相关,近年研究者们将目光集中在了JZ的超微结构上,试图寻找出引起其功能异常的结构基础。本文重点对正常子宫及子宫内膜异位性疾病JZ的生理特性及超微结构进行综述。
Uterine junctional zone(JZ) was first described by Hricak et al in 1983,which is a low signal-intensity zone between myometrium and endometrium on T2-weighted MR images.Subsequent studies confirmed that JZ is located in the innermost layer of the myometrium.It has been confirmed that JZ dysfunction is strongly associated with uterine fibroids、adenomyosis、endometriosis, etc.In recent years, researchers have focused their attention on the ultrastructure of JZ, tring to find out the structural basis that caused the abnormality of JZ.This review focuses on the physiological characteristics and ultrastructure of normal and endometriosis disease uterus JZ.
Uterine junctional zone(JZ) was first described by Hricak et al in 1983,which is a low signal-intensity zone between myometrium and endometrium on T2-weighted MR images.Subsequent studies confirmed that JZ is located in the innermost layer of the myometrium.It has been confirmed that JZ dysfunction is strongly associated with uterine fibroids、adenomyosis、endometriosis, etc.In recent years, researchers have focused their attention on the ultrastructure of JZ, tring to find out the structural basis that caused the abnormality of JZ.This review focuses on the physiological characteristics and ultrastructure of normal and endometriosis disease uterus JZ.
引文
[1]Brown HK, Stoll BS, Nicosia SV, et al.Uterine junctional zone:correlation between histologic findings and MR imaging[J].Radiology, 1991,179(2):409-413.DOI:10.1148/radiology.179.2.1707545.
[2]Novellas S, Chassang M, Delotte J, et al.MRI characteristics of the uterine junctional zone:from normal to the diagnosis of adenomyosis[J].AJR Am J Roentgenol, 2011,196(5):1206-1213.DOI:10.2214/AJR.10.4877.
[3]Fusi L, Cloke B, Brosens JJ.The uterine junctional zone[J].Best Pract Res Clin Obstet Gynaecol, 2006, 20(4):479-491.DOI:10.1016/j.bpobgyn.2006.02.001.
[4]Exacoustos C, Luciano D, Corbett B, et al.The uterine junctional zone:a 3-dimensional ultrasound study of patients with endometriosis[J].Am J Obstet Gynecol, 2013,209(3):248.el-e7.DOI:10.1016/j.ajog.2013.06.006.
[5]Benagiano G, Brosens I, Habiba M.Adenomyosis:a life-cycle approach[J].Reprod Biomed Online, 2015,30(3):220-232.DOI:10.1016/j.rbmo.2014.11.005.
[6]Chen W, Ohara N, Wang J, et al.A novel selective progesterone receptor modulator asoprisnil(J867)inhibits proliferation and induces apoptosis in cultured human uterine leiomyoma cells in the absence of comparable effects on myometrial cells[J].J Clin Endocrinol Metab, 2006,91(4):1296-1304.DOI:10.1210/jc.2005-2379.
[7]Scoutt LM, Flynn SD, Luthringer DJ, et al.Junctional zone of the uterus:correlation of MR imaging and histologic examination of hysterectomy specimens[J].Radiology, 1991,179(2):403-407.DOI:10.1148/radiology.179.2.2014282.
[8]McCarthy S, Scott G, Majumdar S, et al.Uterine junctional zone:MR study of water content and relaxation properties[J].Radiology, 1989,171(1):241-243.DOI:10.1148/radiology.171.1.2928531.
[9]Brown HK, Stoll BS, Nicosia SV, et al.Uterine junctional zone:correlation between histologic findings and MR imaging[J].Radiology, 1991,179(2):409413.DOI:10.1148/radiology.179.2.1707545.
[10]Lesny P, Killick SR.The junctional zone of the uterus and its con-tractions[J].BJOG, 2004, 111(11):1182-1189.DOI:10.1111/j.1471-0528.2004.00350.x.
[11]Fusi L, Cloke B, Brosens JJ.The uterine junctional zone[J].Best Pract Res Clin Obstet Gynaecol, 2006,20(4):479-491.DOI:10.1016/j.bpobgyn.2006.02.001.
[12]Wang J, Ohara N, Takekida S, et al.Comparative effects of heparinbinding epidermal growth factor-like growth factor on the growth of cultured human uterine leiomyoma cells and myometrial cells[J].Hum Reprod, 2005, 20(6):1456-1465.DOI:10.1093/humrep/deh842.
[13]Leonhardt H, Gull B, Kishimoto K, et al.Uterine morphology and peristalsis in women with polycystic ovary syndrome[J].Acta Radiol, 2012,53(10):1195-1201.DOI:10.1258/ar.2012.120384.
[14]Kido A, Togashi K, Kataoka M, et al.The effect of oral contraceptives on uterine contractility and menstrual pain:an assessment with cine MR imaging[J].Hum Reprod, 2007,22(7):2066-2071.DOI:10.1093/humrep/dem122.
[15]Scoutt LM, Flynn SD, Luthringer DJ, et al.Junctional zone of the uterus:correlation of MR imaging and histologic examination of hysterectomy specimens[J].Radiology, 1991,179(2):403-407.DOI:10.1148/radiology.179.2.2014282.
[16]康康,王蔼明,尹善德,等.子宫结合带干细胞的培养与鉴定[J].解放军医学杂志,2015,40(3):173-177.DOI:10.11855/j.issn.0577-7402.2015.03.01.
[17]McCarthy S, Scott G, Majumdar S, et al.Uterine junctional zone:MR study of water content and relaxation properties[J].Radiology, 1989,171(1):241-243.DOI:10.1148/radiology.171.1.2928531.
[18]Novellas S,Chassang M, Delotte J, et al.MRI characteristics of the uterine junctional zone:from normal to the diagnosis of adenomyosis[J].AJR.Am J Roentgenol, 2011,196(5):1206-1213.DOI:10.2214/AJR.10.4877.
[19]Zhang Y, Zhou L, Li TC, et al.Ultrastructural features of endometrial-myometrial interface and its alteration in adenomyosis[J].Int J Clin Exp Pathol, 2014,7(4):1469-1477.
[20]Uduwela AS, Perera MA, Aiqing L, et al.Endometrial-myometrial interface:relationship to adenomyosis and changes in pregnancy[J].Obstet Gynecol Surv, 2000,55(6):390-400.
[21]刘晶晶,段华,汪沙.一氧化氮在子宫腺肌病患者子宫内膜-肌层交界区平滑肌细胞中的表达及意义[J].中华妇产科杂志,2013,48(7):504-507.DOI:10.3760/cma.j.issn.0529-567x.2013.07.006.
[22]Kido A, Togashi K, Nishino M, et al.Cine MR imaging of uterine peristalsis in patients with endometriosis[J].Eur Radiol, 2007,17(7):1813-1819.DOI:10.1007/s00330-006-0494-9.
[23]Leyendecker G, Wildt L, Mall G.The pathophysiology of endometriosis and adenomyosis:tissue injury and repair[J].Arch Gynecol Obstet, 2009,280(4):529-538.DOI:10.1007/s00404-009-1191-0.
[24]Ibrahim MG, Sillem M, Plendl J, et al.Myofibroblasts Are Evidence of Chronic Tissue Microtrauma at the Endometrial-Myometrial Junctional Zone in Uteri With Adenomyosis[J].Reprod Sci,2017,24(10):1410-1418.DOI:10.1177/1933719116687855.
[25]王珺,张恒辉,段华.雌激素受体-a在子宫腺肌病子宫内膜肌层交界区中的表达[J].中华医学杂志,2010,90(27):1914-1917.DOI:10.3760/cma.j.issn.0376-2491.2010.27.011.
[26]贾喜菲,宋静慧,萨日娜.子宫肌瘤、子宫肌瘤合并子宫腺肌病结合带的超微结构变化及Cx43表达[J].中华临床医师杂志:电子版,2013,7(19):8688-8695.DOI:10.3877/cma.j.issn.1674-0785.2013.19.035.
[27]萨日娜,宋静慧.子宫结合带的超微结构及间隙连接蛋白43在子宫结合带中的表达与卵巢子宫内膜异位症发病的意义[J].中华临床医师杂志:电子版,2013,7(24):11299-11304.DOI:10.3877/cma.j.issn.1674-0785.2013.24.048.
[2]Novellas S, Chassang M, Delotte J, et al.MRI characteristics of the uterine junctional zone:from normal to the diagnosis of adenomyosis[J].AJR Am J Roentgenol, 2011,196(5):1206-1213.DOI:10.2214/AJR.10.4877.
[3]Fusi L, Cloke B, Brosens JJ.The uterine junctional zone[J].Best Pract Res Clin Obstet Gynaecol, 2006, 20(4):479-491.DOI:10.1016/j.bpobgyn.2006.02.001.
[4]Exacoustos C, Luciano D, Corbett B, et al.The uterine junctional zone:a 3-dimensional ultrasound study of patients with endometriosis[J].Am J Obstet Gynecol, 2013,209(3):248.el-e7.DOI:10.1016/j.ajog.2013.06.006.
[5]Benagiano G, Brosens I, Habiba M.Adenomyosis:a life-cycle approach[J].Reprod Biomed Online, 2015,30(3):220-232.DOI:10.1016/j.rbmo.2014.11.005.
[6]Chen W, Ohara N, Wang J, et al.A novel selective progesterone receptor modulator asoprisnil(J867)inhibits proliferation and induces apoptosis in cultured human uterine leiomyoma cells in the absence of comparable effects on myometrial cells[J].J Clin Endocrinol Metab, 2006,91(4):1296-1304.DOI:10.1210/jc.2005-2379.
[7]Scoutt LM, Flynn SD, Luthringer DJ, et al.Junctional zone of the uterus:correlation of MR imaging and histologic examination of hysterectomy specimens[J].Radiology, 1991,179(2):403-407.DOI:10.1148/radiology.179.2.2014282.
[8]McCarthy S, Scott G, Majumdar S, et al.Uterine junctional zone:MR study of water content and relaxation properties[J].Radiology, 1989,171(1):241-243.DOI:10.1148/radiology.171.1.2928531.
[9]Brown HK, Stoll BS, Nicosia SV, et al.Uterine junctional zone:correlation between histologic findings and MR imaging[J].Radiology, 1991,179(2):409413.DOI:10.1148/radiology.179.2.1707545.
[10]Lesny P, Killick SR.The junctional zone of the uterus and its con-tractions[J].BJOG, 2004, 111(11):1182-1189.DOI:10.1111/j.1471-0528.2004.00350.x.
[11]Fusi L, Cloke B, Brosens JJ.The uterine junctional zone[J].Best Pract Res Clin Obstet Gynaecol, 2006,20(4):479-491.DOI:10.1016/j.bpobgyn.2006.02.001.
[12]Wang J, Ohara N, Takekida S, et al.Comparative effects of heparinbinding epidermal growth factor-like growth factor on the growth of cultured human uterine leiomyoma cells and myometrial cells[J].Hum Reprod, 2005, 20(6):1456-1465.DOI:10.1093/humrep/deh842.
[13]Leonhardt H, Gull B, Kishimoto K, et al.Uterine morphology and peristalsis in women with polycystic ovary syndrome[J].Acta Radiol, 2012,53(10):1195-1201.DOI:10.1258/ar.2012.120384.
[14]Kido A, Togashi K, Kataoka M, et al.The effect of oral contraceptives on uterine contractility and menstrual pain:an assessment with cine MR imaging[J].Hum Reprod, 2007,22(7):2066-2071.DOI:10.1093/humrep/dem122.
[15]Scoutt LM, Flynn SD, Luthringer DJ, et al.Junctional zone of the uterus:correlation of MR imaging and histologic examination of hysterectomy specimens[J].Radiology, 1991,179(2):403-407.DOI:10.1148/radiology.179.2.2014282.
[16]康康,王蔼明,尹善德,等.子宫结合带干细胞的培养与鉴定[J].解放军医学杂志,2015,40(3):173-177.DOI:10.11855/j.issn.0577-7402.2015.03.01.
[17]McCarthy S, Scott G, Majumdar S, et al.Uterine junctional zone:MR study of water content and relaxation properties[J].Radiology, 1989,171(1):241-243.DOI:10.1148/radiology.171.1.2928531.
[18]Novellas S,Chassang M, Delotte J, et al.MRI characteristics of the uterine junctional zone:from normal to the diagnosis of adenomyosis[J].AJR.Am J Roentgenol, 2011,196(5):1206-1213.DOI:10.2214/AJR.10.4877.
[19]Zhang Y, Zhou L, Li TC, et al.Ultrastructural features of endometrial-myometrial interface and its alteration in adenomyosis[J].Int J Clin Exp Pathol, 2014,7(4):1469-1477.
[20]Uduwela AS, Perera MA, Aiqing L, et al.Endometrial-myometrial interface:relationship to adenomyosis and changes in pregnancy[J].Obstet Gynecol Surv, 2000,55(6):390-400.
[21]刘晶晶,段华,汪沙.一氧化氮在子宫腺肌病患者子宫内膜-肌层交界区平滑肌细胞中的表达及意义[J].中华妇产科杂志,2013,48(7):504-507.DOI:10.3760/cma.j.issn.0529-567x.2013.07.006.
[22]Kido A, Togashi K, Nishino M, et al.Cine MR imaging of uterine peristalsis in patients with endometriosis[J].Eur Radiol, 2007,17(7):1813-1819.DOI:10.1007/s00330-006-0494-9.
[23]Leyendecker G, Wildt L, Mall G.The pathophysiology of endometriosis and adenomyosis:tissue injury and repair[J].Arch Gynecol Obstet, 2009,280(4):529-538.DOI:10.1007/s00404-009-1191-0.
[24]Ibrahim MG, Sillem M, Plendl J, et al.Myofibroblasts Are Evidence of Chronic Tissue Microtrauma at the Endometrial-Myometrial Junctional Zone in Uteri With Adenomyosis[J].Reprod Sci,2017,24(10):1410-1418.DOI:10.1177/1933719116687855.
[25]王珺,张恒辉,段华.雌激素受体-a在子宫腺肌病子宫内膜肌层交界区中的表达[J].中华医学杂志,2010,90(27):1914-1917.DOI:10.3760/cma.j.issn.0376-2491.2010.27.011.
[26]贾喜菲,宋静慧,萨日娜.子宫肌瘤、子宫肌瘤合并子宫腺肌病结合带的超微结构变化及Cx43表达[J].中华临床医师杂志:电子版,2013,7(19):8688-8695.DOI:10.3877/cma.j.issn.1674-0785.2013.19.035.
[27]萨日娜,宋静慧.子宫结合带的超微结构及间隙连接蛋白43在子宫结合带中的表达与卵巢子宫内膜异位症发病的意义[J].中华临床医师杂志:电子版,2013,7(24):11299-11304.DOI:10.3877/cma.j.issn.1674-0785.2013.24.048.