慢性子宫内膜炎的诊治进展

Advances in the Diagnosis and Treatment of Chronic Endometritis

慢性子宫内膜炎(chronic endometritis,CE)是指子宫内膜的慢性持续性炎症,组织学上以内膜间质中浆细胞浸润为特征,其临床症状轻微且不典型,易被忽视。研究发现CE与异常子宫出血、宫腔粘连、不孕症、体外受精(IVF)反复植入失败以及复发性流产等妇科生殖疾病密切相关。临床上诊断CE的传统方法有宫腔镜检查、子宫内膜活检的组织病理学检查和微生物培养。近年来,有学者提出用CD138可特异性标记内膜间质中的浆细胞,从而提高CE的诊断率。另外,逆转录-聚合酶链反应(RT-PCR)检测内膜中的病原体有助于CE的诊断;血液和内膜中的特异性微小RNA(miRNAs)有可能成为CE的分子诊断标记物。目前,CE的标准尚未完全统一。CE的治疗首选抗生素,可选择多西环素、环丙沙星、氧氟沙星、甲硝唑等药物单独或者联合使用,治愈率高。CE治愈可改善不孕症、IVF反复植入失败以及复发性流产患者的妊娠结局。

Chronic endometritis(CE) as the chronic and persistent inflammation of endometrium is characterized by the infiltration of plasma cell in the matrix of endometrium. The clinical symptoms of CE is mild and atypical. As a result, CE is easy to be neglected. CE is closely related to abnormal uterine bleeding, uterine adhesion, infertility, recurrent implantation failure and recurrent miscarriage. The diagnostic methods of CE include hysteroscopy, histopathological examination of endometrium and microorganism culture of endometrium.Recently, researchers propose that immunohistochemical staining of CD138 can specifically recognize plasma cell in the matrix of endometrium and improve the clinical diagnosis rate of CE. In addition, the detection of microorganism by reverse transcription polymerase chain reaction(RT-PCR) also helps the diagnosis of CE.Specific microRNAs in the blood and endometrium are also used as the potential diagnostic markers of CE.However, the diagnostic criteria of CE is still not standardized. The first line treatment of CE is antibiotics(such as doxycycline, ciprofloxacin, ofloxacin, metronidazole, etc.), with a high cure rate. And the treatment of CE improves the pregnancy outcomes of those women with infertility, recurrent implantation failure, and recurrent miscarriage.