探討子宮內膜異位症病患中披衣菌感染的發生率及細胞附著的分子機轉

Chlamydia trachomatis Infection and Cell Adhesion in Patient with Endometriosis

張雅雯(Ya-Wen Chang)

指導教授 ： 楊維中

臺北醫學大學/口腔醫學院/生物醫學材料研究所/碩士(2007年)

摘要

子宮內膜異位症(Endometriosis)是常見的慢性婦科疾病，好發於生殖年齡的婦女，其定義為在骨盆腹膜或子宮腔外發現子宮內膜的腺體(Gland)與基質細胞(Stroma cell)，其臨床症狀最常見的為骨盆腔疼痛及不孕。至目前為止，其致病機轉仍不清楚，最被廣為接受的理論為經血逆流理論(Retrograde menstruation)，也就是經血逆行到腹腔。砂眼披衣菌(Chlamydia trachomatis)是常見的細菌性性傳染病，常造成婦女骨盆腔疼痛及子宮、輸卵管沾黏，與子宮內膜異位症部分病徵相似，因此本論文研究第一部分在探討子宮內膜異位症患者的披衣菌感染盛行率，以患者腹腔液檢體進行披衣菌的ELISA及PCR檢測，發現患者呈現披衣菌陽性反應的百分比較對照組高。同時以子宮內膜異位症患者腹腔液檢測披衣菌的感染，陽性反應的百分比較傳統利用陰道檢測的方式來得高，推測子宮內膜異位症可能與披衣菌上行感染有關。
子宮內膜異位症雖為良性疾病，卻有沾粘、侵犯和轉移等類似癌症的病理特性，而細胞間的貼附和移動又與細胞外間質(Extracellular matrix, ECM)及細胞黏著分子(Cell adhesion molecules, CAM)有關，因此本論文研究第二部分探討子宮內膜異位症患者的原位及異位子宮內膜組織，與正常婦女的子宮內膜組織的細胞外間質與細胞黏著分子的表現有無差異，利用ECM與CAM微陣列(Microarray)實驗及基因表現分析子宮內膜組織，並進一步用西方墨點法做蛋白質表現分析後發現，一些細胞外間質及細胞黏著分子的表現的確在異位的子宮內膜組織與原位及正常婦女的子宮內膜組織比較有差異。此外，一種存在於細胞外間質的醣蛋白SPARC (Secreted protein acidic and rich in cysteine)，於患者異位的子宮內膜組織中表現較正常婦女的子宮內膜組織明顯，而先前並無相關文獻探討SPARC在子宮內膜異位症患者的異位組織中的表現，因此，本研究將著重在SPARC在子宮內膜異位症形成的過程中可能扮演的角色作進一步探討。

關鍵字

砂眼披衣菌 ； 子宮內膜異位症 ； 細胞外間質 ； 細胞黏著分子

並列摘要

Endometriosis is a common chronic gynecological disease affecting the female population during their reproductive life. The definition of endometriosis is presence of endometrial glands and stroma within the pelvic peritoneum and other extrauterine sites. The common clinical symptoms of endometriosis are pelvic pain and infertility. Until now, the pathogenesis of endometriosis remains poorly defined. The most widely accepted theory is Sampson's theory of retrograde menstruation. Chlamydia trachomatis is the most common cause of bacterially-acquired sexually transmitted disease. It can induce pelvic pain, uterus and fallopian tubes adhesion formation. The symptoms caused by Chlamydia trachomatis infection are similar to endometriosis. For this reason, the study aims to investigate the prevalence of Chlamydia trachomatis in women with endometriosis. Peritoneal fluids, obtained from patient were assayed for Chlamydia trachomatis by ELISA and PCR. The percentage of positive was higher in peritoneal fluids from women with endometriosis than in the control. Our studies demonstrated that genital tract test for Chlamydia trachomatis may not sufficient to identify the infection of Chlamydia trachomatis in patients with endometriosis. Endometriosis maybe related to the upper infection of Chlamydia trachomatis.
Although endometriosis is a benign disease, its properties of adhesion, invasion and metastasis are similar to malignant tumor. Extracellular matrix (ECM) and cell adhesion molecules (CAM) are involved in cell adhesion and movement. Therefore, the second part of this study aims to analyze the differences in the expressions of ECM and CAM between eutopic and ectopic endometrium in patients with endometriosis and their expressions compared to women without endometriosis. Microarry and RT-PCR were used to analyze the mRNA expression pattern in endometrium. Western blot analyses were carried out to confirm the identified ECM and CAM expression in the endometrium. The results showed that SPARC (Secreted protein acidic and rich in cysteine), an extracellular glycoprotein, was expressed significantly in ectopic endometrium in patients with endometriosis compared to eutopic endometrium in the control women without endometriosis. The increased expression of SPARC in ectopic endometrium with endometriosis has not been reported in the literature. The possible roles of SPARC play in the progression of endometriosis are discussed.

並列關鍵字

Chlamydia trachomatis ； Endometriosis ； Extracellular matrix ； Cell adhesion molecules ； SPARC

參考文獻

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