胚胎反复种植失败的子宫内膜免疫因素及其研究进展

Research Progress on Endometrial Immune Factors of Recurrent Implantation Failure

胚胎反复种植失败(RIF)是体外受精-胚胎移植(IVF-ET)临床妊娠率的重要限制因素,而子宫内膜免疫相关因素对RIF发生有重要影响。子宫内膜中存在多种免疫细胞,包括自然杀伤细胞(NK细胞)、巨噬细胞(Mφ)、树突状细胞(DC)和T细胞等,在调节子宫内膜容受性和胚胎植入中发挥重要作用。内膜中免疫相关的细胞因子,包括白细胞介素6(IL-6)、IL-10、IL-15、IL-17、肿瘤坏死因子α(TNF-α)、γ干扰素(IFN-γ)和核因子κB(NF-κB)等,对胚胎黏附、滋养细胞侵入、血管重构和免疫耐受的影响也参与决定胚胎植入和发育。子宫内膜免疫失衡在RIF发生中发挥重要作用,但目前对于RIF患者是否应使用免疫治疗尚无高级别循证医学证据。

Embryo recurrent implantation failure(RIF)is an important limiting factor for the clinical success rate of in vitro fertilization and embryo transfer(IVF-ET),and endometrial immunity-related factors have an important influence on the occurrence of RIF.A variety of immune cells in endometrium,including natural killer cells(NK cells),macrophages(Mφ),dendritic cells(DC)and T cells,play an important role in the regulation of endometrial receptivity and embryo implantation.Many of immune-related cytokines in endometrium,including IL-6,IL-10,IL-15,IL-17,TNF-α,IFN-γand NF-κB,also contribute to embryo adhesion,trophoblast invasion,vascular remodeling and immune tolerance,which determine embryo implantation and development.Endometrial immune imbalance plays an important role in the pathological mechanism of RIF,but there is no high-level and evidence-based medical evidence for whether patients with RIF should be treated with immunotherapy.