STUDY QUESTION Are there neurobiological changes induced by endometriosis? SUMMARY ANSWER Women with endometriosis demonstrate specific neurobiological changes distinct from those in patients with chronic pelvic pain (CPP) in the absence of endometriosis. WHAT IS KNOWN ALREADY Endometriosis is a chronic disease affecting women of reproductive age that presents with pain and infertility often accompanied by comorbid mental disorders. Only one study with a number of limitations has investigated changes in gray matter volumes and functional connectivity in a small group of patients with endometriosis. STUDY DESIGN, SIZE, DURATION This prospective study recruited 53 women undergoing a laparoscopy due to suspicion of symptomatic endometriosis and 25 healthy, pain-free women. Clinical and psychological characteristics, thermal pain perception, and voxel- and surface-based morphology were assessed in all study participants. Thereafter, the patients underwent a laparoscopy, where endometriosis was either histologically confirmed and removed, or ruled out. Correspondingly, patients were assigned into the group with endometriosis (n = 27) or with endometriosis-independent CPP (n = 26) and compared to the pain-free controls. PARTICIPANTS/MATERIALS, SETTING, METHODS The study groups were generally representative for the population of women with endometriosis. Sociodemographic, medical, clinical, and psychological characteristics were collected using various questionnaires and a structured clinical interview. Thermal pain perception and voxel- and surface-based morphometry were assessed using thermode and MRI, respectively. MAIN RESULTS AND THE ROLE OF CHANCE Despite comparable pain intensity and burden of mental disorders, both patient groups demonstrated distinct neurobiological patterns. Women with endometriosis exhibited increased gray matter volume (GMV) in the left cerebellum, lingual gyrus and calcarine gyrus, compared to those with endometriosis-independent CPP. Patients with CPP had decreased GMV in the right cerebellum as compared to controls. Dysmenorrhoea severity correlated positively with GMV in the left inferior parietal lobule, whereas depressive symptoms were associated with decreased GMV in the right superior medial gyrus across patient groups. Dyspareunia correlated negatively with cortical thickness in the left inferior temporal gyrus and left middle temporal gyrus. LIMITATIONS, REASONS FOR CAUTION The study groups differed in a few baseline-characteristics, including educational levels, smoking and BMI. While measuring pain perception thresholds, we did not attempt to mimic CPP by placement of the thermode on the abdominal wall. WIDER IMPLICATIONS OF THE FINDINGS Changes in gray matter volume associated with endometriosis differ from those observed in women with endometriosis-independent CPP. Our results underline an involvement of the cerebellum in pain perception and the pathogenesis of pain associated with endometriosis. STUDY FUNDING/COMPETING INTEREST(S) This work was funded by the START Program of the Faculty of Medicine, RWTH Aachen, Germany, and supported by the International Research Training Group (IRTG 2150) of the German Research Foundation (DFG)—269953372/GRK2150, Germany. S.T. was supported by postdoctoral fellowship of the Faculty of Medicine, RWTH Aachen, Germany. There are no conflicts of interest. TRIAL REGISTRATION NUMBER DRKS00021236

中文翻译：

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子宫内膜异位症合并子宫内膜异位症非依赖性慢性盆腔疼痛女性的心理特征和脑结构变化


研究问题子宫内膜异位症是否会引起神经生物学变化？摘要 答案 子宫内膜异位症女性表现出与无子宫内膜异位症的慢性盆腔疼痛 （CPP） 患者不同的特异性神经生物学变化。众所周知，子宫内膜异位症是一种影响育龄妇女的慢性疾病，表现为疼痛和不孕症，通常伴有精神障碍。只有一项存在许多局限性的研究调查了一小群子宫内膜异位症患者灰质体积和功能连接的变化。研究设计、大小、持续时间 这项前瞻性研究招募了 53 名因怀疑有症状的子宫内膜异位症而接受腹腔镜检查的女性和 25 名健康、无痛的女性。对所有研究参与者的临床和心理特征、热痛感知以及基于体素和表面的形态进行了评估。此后，患者接受了腹腔镜检查，其中子宫内膜异位症要么经组织学证实并切除，要么被排除。相应地，将患者分为子宫内膜异位症组 （n = 27） 或子宫内膜异位症非依赖性 CPP 组 （n = 26），并与无痛对照组进行比较。参与者/材料、环境、方法 研究组通常代表子宫内膜异位症女性人群。使用各种问卷和结构化临床访谈收集社会人口学、医学、临床和心理特征。分别使用 thermode 和 MRI 评估热痛感知以及基于体素和表面的形态测量。 主要结果和机会的作用 尽管疼痛强度和精神障碍负担相当，但两组患者都表现出不同的神经生物学模式。与子宫内膜异位症非依赖性 CPP 患者相比，子宫内膜异位症女性左小脑、舌回和钙质回的灰质体积 （GMV） 增加。与对照组相比，CPP 患者右小脑的 GMV 降低。痛经严重程度与左侧顶下小叶的 GMV 呈正相关，而抑郁症状与患者组中右侧内侧上回的 GMV 降低相关。痛与左颞下回和左中颞回的皮质厚度呈负相关。局限性，谨慎的原因 研究组在一些基线特征上有所不同，包括教育水平、吸烟和 BMI。在测量疼痛感知阈值时，我们没有尝试通过将 thermode 放置在腹壁上来模拟 CPP。研究结果的更广泛意义 与子宫内膜异位症相关的灰质体积变化与在子宫内膜异位症非依赖性 CPP 女性中观察到的变化不同。我们的结果强调了小脑参与疼痛感知和子宫内膜异位症相关疼痛的发病机制。研究资金/利益争夺 这项工作由德国亚琛工业大学医学院 START 计划资助，并得到德国研究基金会 （DFG） 国际研究培训小组 （IRTG 2150） 的支持——269953372/GRK2150。ST 得到了德国亚琛工业大学医学院博士后奖学金的支持。没有利益冲突。试验注册号 DRKS00021236