RESUMO
The systematic analysis of immunity status in the peritoneum of women with endometriosis, is presented. Twenty five patients were studied, distributed as follows: A. Endometriosis, B. Sterility of non identified cause. In all the patients, peritoneal fluid was obtained (PF) during diagnostic laparoscopy, and a sample of peripheral blood was taken simultaneously. Both samples were processed analysis of lymphocytes subpopulations (ALS) by flux cytometry using monoclonal antibodies with reactivity to lymphocytes T total (CD+), lymphocytes B (CD19+), auxiliatory/inductory (CD3+CD4+), suppressor/cytotoxic (CD3+CD8+) and NK (CD3+CD16+ + 56+). The peritoneal ALS of both groups were characterized by a clear lymphocyte B diminution, moderate diminution of activators; a considerable increase of suppressors; altered CD4+/CD8+ relation in favour of suppression and NK diminution when comparing with its own blood compartment. All of these values were identical for both groups, and the only significant difference was found when comparing activated lymphocytes T subpopulation that was lesser in PF of women with endometriosis. This is the only fact that backs up the existence of altered immunity in the peritoneum of these patients, that affects the expression of activated lymphocytes. However, taking as a criterium the rest of subpopulations, in endometriosis as well as in ECNI the microenvironment goes for suppression and they are not distinguishable among them. On other side, it started signal characterization that conditions suppression induction for lymphocytes activation in peritoneal environment of women with endometriosis. Ten samples of PF of patients using peripheral purified lymphocytes by density gradient of voluntary donnors, normal, fertile, were analyzed. Cells were cultivated and stimulated in vitro with concanavaline A in presence of timidine 3H. In experimental holes PF was added at dose-response concentration, and it was evaluated as the difference in synthesis of radioactive ADN against the incubated cells in absence of PF. It was possible to demonstrate the presence of associated factors in PF of patients with endometriosis that inhibit proliferation of lymphocytes stimulated by Con A, and not so in samples of ECNI. With these factors one supposes the presence of soluble signals that condition local immunological suppression.
Assuntos
Endometriose/imunologia , Peritônio/imunologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Subpopulações de Linfócitos , Estudos ProspectivosRESUMO
Patient with primary sterility; antecedent of tubal surgery and damaged tuboperitoneal factor; she was programmed for in vitro fertilization with embryo transference. She had ovarian hyperstimulation with pure FSH and menotropins; follicular aspiration, via vagina with ultrasonographic guidelines. Seven days after, she presented with colic pain at left iliac region a hard, painful mass was found at left iliac region. Uterus deviated to the right, painful to movement; left vaginal cul de sac increased in volume and left adnexal tumor, without limits; left pararectal tumor. Exploratory laparoscopy was done, with pelvic abscess drainage, 10 to 12 cm, and left oophorectomy; the diagnosis was left pyo-ovary. Normal evolution.