子宫内膜搔刮对反复种植失败患者Wnt信号通路及其调节因子的影响

Effect of Endometrial Scratching on Wnt Signaling Pathway and Its Regulatory Factors in Repeated Inplantation Patients

【目的】探讨子宫内膜搔刮对反复种植失败(RIF)患者Wnt信号通路及其调节因子的影响。【方法】前瞻性纳入2015年12月至2018年1月在本院因输卵管因素不孕行体外助孕治疗的RIF患者87例,其中搔刮组43例[患者于胚胎移植(ET)的前1个月经周期月经来潮6h内进行内膜搔刮],对照组44例(在冻胚复苏ET前未行内膜搔刮)。采用蛋白质印迹法和Realtime PCR检测患者排卵后5-7d子宫内膜种植窗口期β-catenin、cyclinDl、Pygo2及DKK1表达水平,比较两组胚胎着床率、临床妊娠率、持续妊娠率。【结果】搔刮组胚胎着床率、临床妊娠率及持续妊娠率均显著高于对照组,其差异有统计学意义(P<0.05)。ET前,两组患者β-catenin、cyclinD1、Pygo2和抑制因子DKK1水平比较差异无统计学意义(P>0.05);ET后,搔刮组β-catenin、cyclinD1、Pygo2表达量明显高于对照组,而DKK1表达量明显低于对照组(P<0.001)。【结论】施行子宫内膜ET后,RIF患者Wnt信号通路β-catenin、cyclinD1、Pygo2表达量升高,调节因子抑制因子DKK1表达下降,可通过改善子宫内膜容受性,提高R1F患者的临床妊娠率。

【Objective】 To investigate the effect of endometrial curettage on Wnt signaling pathway and its regulatory factors in recurrent implantation failure (RIF) patients.[Methods] The prospective study recruited a total of 87 patients with RIF who underwent in vitro fertilization in our hospital due to fallopian tube factors sterility from December 2015 to January 2018. There were 43 cases in the endometrial scraping group (the patients underwent endometrial scraping within 6 h of menstrual cramps during the first 1 month of the frozen embryo resuscitation), and 44 cases in the control group (no endometrial scraping before the frozen embryo resuscitation). The expression levels of β-catenin, cyclinD1, Pygo2 and DKK1 were detected by western blotting and real-time PCR in the endometrial implantation window 5-7 days after ovulation. The pregnancy-related conditions (implantation rate, clinical prgenancy rate and sustained pregnancy rate) were determined and compared between the two groups.[Results]Embryo implantation rate, clinical pregnancy rate and sustained pregnancy rate in scraping group were significantly higher than those in control group ( P <0.05). There was no significant difference in the levels of β-catenin, cyclin D1, Pygo2 and inhibitory factor DKK1 between the scratching group and the control group before scratching ( P >0.05). After scratching the expressions of pcatenin, cyclin D1 and Pygo2 in the scratching group were significantly higher than those in the control group, while the expression of DKK1 was significantly lower than that in the control group ( P <0.001).[Conclusion]After endometrial curettage, the expression of β-catenin, cyclinD1, and Pygo2 in RIF patients is increased and the expression of inhibitory factor DKK1 is decreased. which can improve the clinical pregnancy rate of patients with RIF by improving endometrial receptivity.