轻刮子宫内膜对胚胎着床因子和反复妊娠失败患者妊娠结局影响研究

Influence of endometrial scratching on embryo implantation factors and pregnancy outcomes in patients with repeated pregnancy failure

目的:研究探索轻刮子宫内膜对骨桥蛋白(OPN)、白血病抑制因子(LIF)、胞饮突、整合素αVβ3的表达水平和反复妊娠失败患者再次妊娠结局所产生的影响。方法:采用随机数字表法将300例反复妊娠失败患者均分为两组。观察组在月经第2天行子宫内膜轻刮术;对照组未进行此项手术。B超监测患者排卵情况,卵泡直径达到18 cm以上时指导患者同房。选择免疫组化法测定两组患者胚胎着床期子宫内膜中OPN、LIF、整合素αVβ3表达情况,扫描电镜下观察胞饮突表达情况,对比两组患者妊娠结局。结果:观察组经轻刮术后,患者子宫内膜中OPN、LIF及整合素αVβ3表达较对照组均明显增强,胞饮突较对照组表达更丰富;妊娠率及活产率均明显高于对照组,差异均具有统计学意义(P<0.05);两组中妊娠者子宫内膜中OPN、LIF及整合素αVβ3的表达均明显高于非妊娠者,胞饮突丰富表达者比例明显高于非妊娠者,表达较少者比例明显低于非妊娠者,差异均具有统计学意义(P<0.05)。结论:子宫内膜中OPN、LIF、整合素αVβ3及胞饮突是胚胎着床期的重要相关因子,子宫内膜轻刮术可明显增强其表达,改善患者子宫内膜容受性,提高胚胎着床率,改善反复妊娠失败患者的妊娠结局。

Objective:To explore the influence of endometrial scratching on the expression levels of osteopontin(OPN),leukemia inhibitory factor(LIF),pinopode,integrin αVβ3,and the outcome of re-pregnancy in patients with repeated pregnancy failure. Methods:A total of 300 patients with repeated pregnancy failure were divided into two groups by random number table method. The observation group underwent endometrial scratching on the second day of menstruation,and the control group did not performed this operation. All the patients were instructed to have intercourse when ultrasound test showed the ovarian follicle diameter ≥18 cm. Immunohistochemistry was used to determine the expression of OPN,LIF,and integrin αVβ3 in the endometrium of the two groups. Scanning electron microscopy was used to observe the expression of pinopode of the two groups. Pregnancy outcomes were also compared between two groups. Results:The expression levels of OPN,LIF and integrin αVβ3 in the observation group were significantly higher than those in the control group,and the expression of pinopode was more abundant than that in the control group,the pregnancy rate and live birth rate were significantly higher than those in the control group,the differences were statistically significant(P<0.05). In both groups,the expression levels of OPN,LIF and integrin αVβ3 in the endometrium of pregnant patients were significantly higher than those of non-pregnant patients,and the proportion of rich pinopode in pregnant patients was significantly higher than that in non-pregnant patients,the differences were statistically significant(P<0.05). Conclusion:The OPN,LIF,integrin αVβ3 and pinopode in the endometrium are important factors related to embryo implantation. Endometrial scratching can significantly enhance the expression of OPN,LIF,integrin αVβ3 and pinopode,improve the endometrial receptivity of patient,improve embryo implantation rate,and improve the pregnancy outcomes of patients with repeated pregnancy failure.