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山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (3): 55-59.doi: 10.6040/j.issn.1671-7554.0.2020.1614

• 临床医学 • 上一篇    下一篇

慢性子宫内膜炎对子宫内膜异位症相关性不孕妊娠结局的影响

梁炎春1,叶海花2,陆丽美2,戴郁菁3,程谦益3,蔡婉玲3,曾涵秋3,陈杏欢3,王兴3,韦雅婧1,杨如玉1   

  1. 1. 中山大学附属第一医院妇产科, 广东 广州 510080;2. 南宁市武鸣区妇幼保健院妇产科, 广西 南宁 530100;3. 中山大学中山医学院, 广东 广州 510080
  • 发布日期:2021-04-06
  • 通讯作者: 梁炎春. E-mail:liangyanchun1987@126.com
  • 基金资助:
    国家自然科学基金青年科学基金(81701416);2019年广东大学生科技创新培育重点项目(pdjh2019a0004);2020年广东省科技创新战略“攀登计划”专项基金(pdjh2020b0015);2020年中山大学大学生创新训练计划项目(20201219,20201220);2019年南宁市科学研究与技术重点研发计划(ZS20190136)

Effects of chronic endometritis on the pregnancy outcomes of patients with endometriosis-associated infertility

LIANG Yanchun1, YE Haihua2, LU Limei2, DAI Yujing3, CHENG Qianyi3, CHOI Unleng3, ZENG Hanqiu3, CHEN Xinghuan3, WANG Xing3, WEI Yajing1, YANG Ruyu1   

  1. 1. Department of Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong, China;
    2. Department of Gynecology, Wuming Maternal and Child Health Hospital of Nanning, Nanning 530100, Guangxi, China;
    3. Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
  • Published:2021-04-06

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摘要： 目的 探讨慢性子宫内膜炎(CE)在子宫内膜异位症相关性不孕(EAI)患者中发生的高危因素及对患者妊娠预后的影响。 方法 选择2018年6月1日至2019年6月1日因不孕进行宫腹腔镜联合诊治术的患者122例作为研究对象,所有患者经腹腔镜手术和术后病理证实为子宫内膜异位症(EMs)。根据CE的两种诊断标准,将研究对象分为慢性子宫内膜炎组和非慢性子宫内膜炎组,统计分析CE发生的高危因素,并追踪和比较两组患者术后不同时间段的累积妊娠率。 结果 按高倍镜下1个或以上浆细胞为诊断标准,EAI患者中合并CE的比例是82.79%(101/122),输卵管粘连(P=0.008)是其发生的高危因素。按高倍镜下5个或以上浆细胞为诊断标准,EAI患者中合并CE的比例是54.1%(66/122),合并的其他妇科疾病(包括子宫肌瘤、多囊卵巢综合征等)是其发生的高危因素。无论采用何种诊断标准,EAI同时合并CE的患者在经过规范的抗生素疗程治疗之后,其术后的6、9、12个月的累积妊娠率与无合并CE的EAI患者之间差异无统计学意义(P>0.05)。 结论 CE在EAI患者中发生率高;输卵管粘连或同时合并多囊卵巢综合征、子宫肌瘤等基础妇科疾病,可能是EAI同时合并CE的高危因素。规范的抗生素治疗可以改善EAI合并CE患者的妊娠预后。

关键词: 慢性子宫内膜炎, 子宫内膜异位症, 不孕, CD138

Abstract: Objective To investigate the risk factors of chronic endometritis(CE)in patients with endometriosis-associated infertility(EAI), and to explore the effects of CE on the pregnancy outcomes of such patients. Methods Patients undergoing laparoscopic and hysteroscopic surgery for infertility during June 1, 2018 and June 1, 2019 were collected. All cases were laparoscopically diagnosed and pathologically confirmed as endometriosis. According to the two different diagnostic criteria of CE, patients were divided into CE group and non-CE group. Risk factors of CE were analyzed. The cumulative pregnancy rates of the two groups at different time periods after surgery were compared. Results When ≥1 CD138 positively stained plasma cells observed in endometrial stroma under one high power field was used as the diagnostic criterion, the prevalence of CE in patients with EAI was 82.79%(101/122); fallopian tube adhesion(P=0.008)was the risk factor. When ≥5 CD138 positively stained plasma cells observed was used as the diagnostic criterion, the prevalence of CE was 54.1%(66/122); other gynecologic diseases(myoma, polycystic ovarian syndrome, etc.)(P=0.002)were the risk factor. Whatever the criterion was, after standardized antibiotic treatment, 6, 9 and 12 months after surgery, the differences in the cumulative pregnancy rates in patients with CE and without CE were not statistically significant(P>0.05). Conclusion The prevalence of CE in patients with EAI is high; fallopian tube adhesion and complicated gynecologic diseases are the risk factors of CE in such patients. Standardized antibiotic treatment can improve the pregnancy outcomes.

Key words: Chronic endometritis, Endometriosis, Infertility, CD138

中图分类号: 

  • R711.71
[1] 叶海花, 陆丽美, 戴郁菁, 等. 慢性子宫内膜炎的诊治进展[J]. 国际生殖健康/计划生育杂志, 2019, 38(6): 514-518. YE Haihua, LU Limei, DAI Yujing, et al. Advances in the diagnosis and treatment of chronic endometritis[J]. Journal of International Reproductive Health/Family Planning, 2019, 38(6): 514-518.
[2] Puente E, Alonso L, Lagana AS, et al. Chronic endometritis: old problem, novel insights and future challenges [J]. Int J Fertil Steril, 2020, 13(4): 250-256.
[3] Song D, Feng X, Zhang Q, et al. Prevalence and confounders of chronic endometritis in premenopausal women with abnormal bleeding or reproductive failure [J]. Reprod Biomed Online, 2018, 36(1): 78-83.
[4] Park HJ, Kim YS, Yoon TK, et al. Chronic endometritis and infertility [J]. Clin Exp Reprod Med, 2016, 43(4): 185-192.
[5] Lee D, Kim SK, Lee JR, et al. Management of endometriosis-related infertility: considerations and treatment options [J]. Clin Exp Reprod Med, 2020, 47(1): 1-11.
[6] Ettore C, Giuseppe T, Marcella M, et al. Higher prevalence of chronic endometritis in women with endometriosis: a possible etiopathogenetic link [J]. Fertil Steril, 2017, 108(2): 289-295.
[7] Kimura F, Takebayashi A, Ishida M, et al. Review: chronic endometritis and its effect on reproduction [J]. J Obstet Gynaecol Res, 2019, 45(5): 951-960.
[8] Ticconi C, Pietropolli A, Di Simone N, et al. Endometrial immune dysfunction in recurrent pregnancy loss [J]. Int J Mol Sci, 2019, 20(21): 5332. doi: 10.3390/ijms20215332.
[9] Zondervan KT, Becker CM, Missmer SA. Endometriosis [J]. N Engl J Med, 2020, 382(13): 1244-1256.
[10] Vallve-Juanico J, Houshdaran S, Giudice LC. The endometrial immune environment of women with endometriosis [J]. Hum Reprod Update, 2019, 25(5): 564-591.
[11] de Rivero VJ. The inflammasome in reproductive biology: a promising target for novel therapies [J]. Front Endocrinol(Lausanne), 2020, 11: 8. doi: 10.3389/fendo.2020.00008.
[12] Garcia-Gomez E, Vazquez-Martinez ER, Reyes-Mayoral C, et al. Regulation of inflammation pathways and inflammasome by sex steroid hormones in endometriosis [J]. Front Endocrinol(Lausanne), 2019, 10: 935. doi: 10.3389/fendo.2019.00935.
[13] Le NXH, Loret de Mola JR, Bremer P, et al. Alteration of systemic and uterine endometrial immune populations in patients with endometriosis [J]. Am J Reprod Immunol, 2021, 85(3): e13362. doi: 10.1111/aji.13362.
[14] Khan KN, Yamamoto K, Fujishita A, et al. Differential levels of regulatory T cells and T-Helper-17 cells in women with early and advanced endometriosis [J]. J Clin Endocrinol Metab, 2019, 104(10): 4715-4729.
[15] Pedro-Antonio R, Anna M, Manuela S, et al. Chronic inflammation in PCOS: the potential benefits of specialized pro-resolving lipid mediators(SPMs)in the improvement of the resolutive response [J]. Int J Mol Sci, 2020, 22(1): 384. doi: 10.3390/ijms22010384.
[16] Kitaya K, Matsubayashi H, Takaya Y, et al. Live birth rate following oral antibiotic treatment for chronic endometritis in infertile women with repeated implantation failure [J]. Am J Reprod Immunol, 2017, 78(5): e12719. doi: 10.1111/aji.12719.
[17] Khan KN, Fujishita A, Kitajima M, et al. Intra-uterine microbial colonization and occurrence of endometritis in women with endometriosis [J]. Hum Reprod, 2014, 29(11): 2446-2456.
[18] Wang XM, Ma ZY, Song N. Inflammatory cytokines IL-6, IL-10, IL-13, TNF-alpha and peritoneal fluid flora were associated with infertility in patients with endometriosis [J]. Eur Rev Med Pharmacol Sci, 2018, 22(9): 2513-2518.
[19] Akiyama K, Nishioka K, Khan KN, et al. Molecular detection of microbial colonization in cervical mucus of women with and without endometriosis [J]. Am J Reprod Immunol, 2019, 82(2): e13147. doi: 10.1111/aji.13147.
[20] 陈思凯, 谷智越, 郑萍, 等. 并发不孕的子宫内膜异位症患者阴道菌群的微生物组学研究[J]. 国际妇产科学杂志, 2020, 47(2): 227-231. CHEN Sikai, GU Zhiyue, ZHENG Ping, et al. The microbiome study of vaginal bacteria in endometriosis patients with infertility [J]. Journal of International Obstetrics and Gynecology, 2020, 47(2): 227-231.
[21] Wee BA, Thomas M, Sweeney EL, et al. A retrospective pilot study to determine whether the reproductive tract microbiota differs between women with a history of infertility and fertile women [J]. Aust N Z J Obstet Gynaecol, 2018, 58(3): 341-348.
[22] Kyono K, Hashimoto T, Nagai Y, et al. Analysis of endometrial microbiota by 16S ribosomal RNA gene sequencing among infertile patients: a single-center pilot study [J]. Reprod Med Biol, 2018, 17(3): 297-306.
[23] Chen C, Song X, Wei W, et al. The microbiota continuum along the female reproductive tract and its relation to uterine-related diseases [J]. Nat Commun, 2017, 8(1): 875. doi: 10.1038/s41467-017-00901-0.
[24] Koninckx PR, Ussia A, Tahlak M, et al. Infection as a potential cofactor in the genetic-epigenetic pathophysiology of endometriosis: a systematic review [J]. Facts Views Vis Obgyn, 2019, 11(3): 209-216.
[25] Lin KY, Chang CY, Lin WC, et al. Increased risk of endometriosis in patients with endometritis- a nationwide cohort study involving 84,150 individuals [J]. Ginekol Pol, 2020, 91(4): 193-200.
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