种植窗期子宫内膜自然杀伤细胞对内膜血管生成的影响及子宫动脉血流与体外受精胚胎移植结局的相关性

Effect of uterine natural killer cells in the window endometrium of implantation on angiogenesis and relationship between uterine artery pulsation index and IVF treatment outcome

目的探讨种植窗期子宫内膜自然杀伤细胞(uNK)对血管生成的影响及子宫动脉血流与胚胎种植的相关性。方法选择年龄小于35岁行体外受精-胚胎移植患者30例,检测种植窗期子宫动脉搏动指数,收集种植窗期子宫内膜,免疫组化SP法检测子宫内膜uNK细胞标记物CD56+、血管内皮细胞标记物F8因子及内膜血管平滑肌细胞标记物α-平滑肌肌动蛋白(αSMA)、重链肌球蛋白(SMM)的表达、定位。随访助孕结局,根据是否临床妊娠及至少有2次或2次以上的体外受精-胚胎移植助孕失败史,分为妊娠组和反复种植失败组。结果①uNK细胞的阳性表达率与F8因子的阳性表达率呈正相关(r=0.581,P<0.01)。②uNK细胞的阳性表达率与αSMA、SMM的阳性表达率呈正相关(r=0.572,r=0.569,P<0.01)。③反复种植失败组和妊娠组子宫动脉搏动指数分别为(0.85±1.51;0.93±0.24),差异无统计学意义(t=-0.98,P>0.05)。结论①人种植窗期子宫内膜uNK细胞与微血管密度、血管成熟度呈正相关,提示uNK细胞在种植窗期子宫内膜血管生成中起重要作用;②子宫动脉搏动指数对胚胎移植结局的影响,妊娠组和反复种植失败组之间无统计学差异,有待进一步探讨。

Objective To investigate the effect of uterine natural killer （uNK） cells in the endometrium of implantation window stage on endometrial angiogenesis and the relationship between uterine artery pulsation index and in vitro fertilization （IVF） treatment outcome. Methods We recruited 30 patients who all had received IVF and embryo transfer （IVF-ET） at the age of less than 35 years. Uterine artery pulsation indexes were assessed by vaginal color Doppler, and the endometrium in the window of implantation was collected. Expression and localization of CD56＋, uNK cells marker; F8 factor, vascular endothelial cell marker; alpha smooth muscle actin （αSMA）, vascular smooth muscle cell marker; and heavy chain smooth myosin （SMM） were detected by immunohistochemical SP method. The patients were divided into pregnancy group and repeated implantation failure group based on assisted pregnancy outcome. Results ① The positive expression rates of uNK cells and F8 factorwere positively related （r=0. 581, P〈0.01）. ② The positive expression rate of uNK cells was positively related tothat of αSMA and SMM （r =0. 572, r=0. 569, P〈0. 01） ③Uterine artery pulsation index was 0. 85±1.51 inrepeated implantation failure group and 0. 93 ±0. 24 in pregnancy group, without any significant difference betweenthe two groups （t =- 0.98, P〉0. 05）. Conclusion O uNK cells in the window of implantation are positivelycorrelated with microvascular density and vascular maturity, indicating that they play an important role inangiogenesis of the endometrium. ② The effect of uterine artery dynamic index on embryo transfer outcome doesnot differ significantly between pregnancy group and repeated implantation failure group. Further study is needed.