子宫内膜异位症患者内膜容受性及“种植窗”的特点

Characteristic of Endometrial Receptivity and Implantation Window in Women with Endometriosis

子宫内膜异位症(EMs)通过多个环节影响女性生育能力和不孕的治疗效果。EMs合并不孕的患者其子宫内膜细胞学形态方面:胞饮突的表达量、内膜腺体数目、基质有丝分裂细胞数较健康对照组均显著减少,腺体的腺腔分布不规则,微绒毛少、纤毛再生不全、发育不良;分子生物学方面:种植窗期内膜整合素αvβ3减少,基质金属蛋白酶-9(MMP-9)、细胞外基质、激活素A、细胞黏附分子、芳香化酶P450、IgG和IgA抗体等多种细胞因子的异常;基因学方面:HOXA10、HOXA11基因呈低水平表达,MMP-2和MMP-9表达升高;类固醇激素17β-羟基类固醇脱氢酶(17β-HSDs)等不表达,从而降低EMs患者的子宫内膜容受性。促性腺激素释放激素激动剂预处理可有效提高EMs患者子宫内膜容受性。

Endometriosis （EMs） can affect females＇ ability of fertility and therapeutic effect of infertility through various processes. There are many aspects to exam the differences of endometrium among patients with both EMs and infertility. Firstly, cytologic aspect： expression quantity ofpinopodes, quantity of endometrial glands, quantity of mitotic cells in stromata, of whom are significantly fewer compared with healthy controls. Moerover, the distribution of glandular lumens is irregular, the number of microvilli is few, and cilia is incomplete regeneration and dysplasia. Secondly, from molecular biologic aspect, endometrial integrin Ctv133 within planting window period decrease with abnormality of multiple cytokines such as matrix metalloproteinase-9 （MMP-9）, extracellular matrix, activin-A, cell adhesion molecules, aromatase P450, IgG, IgA, ect. Thirdly, from genetics, the low level expression of HOXA10 and HOXA11, higher expression of MMP-2 and MMP-9, and non-expression of steroid hormones 1713- hydroxy steroid dehydrogenase （1715-HSDs）, lower the patients＇ endometrium receptivity. In addition, the pretreatment of gonadotropin releasing hormone agonist can improve the endometrium receptivity of women with EMs effectively.