子宫内膜轻创对着床相关因子及IVF妊娠结局影响的研究

目的:探讨子宫内膜轻创术对提高子宫内膜容受性的价值及分子机理。方法:对120例不孕症患者行IVF140周期,随机分为行子宫内膜搔刮轻创术组60例(A组)及对照组60例(B组),采用内膜微活检的方法,在扫描电镜下观察胞饮突,免疫组化定位及半定量检测白血病抑制因子(LIF)、骨桥蛋白(OPN)。再将对照组未孕患者中的20例行轻创术(B2组),重复IVF,并进行相关因子测定。结果:A组和B组相关因子分别为:胞饮突丰富占63.33%和36.67%、LIF6.07±1.33和4.94±2.26、OPN6.36±1.49和5.28±2.06、单胚种植率27.8%和14.3%,组间比较差异均有统计学意义(P<0.05)。B2组行轻创术前后比,分别为:胞饮突丰富10%vs50%,LIF4.50±0.82vs6.33±1.25,OPN5.06±0.98vs6.83±1.46,轻创术前后差异均有统计学意义(P<0.05)。按妊娠与否分组后,妊娠组(n=62)与非妊娠组(n=78)相关因子分别为:胞饮突丰富54.84%和25.64%,LIF6.94±1.03和4.24±1.84,OPN7.31±0.85和4.52±1.65,差异有统计学意义(P<0.05),且LIF与OPN间呈正相关。结论:胞饮突、LIF、OPN是子宫内膜着床期重要的相关因子,它们的高表达与子宫内膜容受性紧密相关。而轻创术可增强3者的表达,从而提高胚胎种植率,改善IVF妊娠结局。

Influence of Local Injury Treatment on theImplantation Related Factors and IVF Pregnancy Outcome

Objective: To explore the value and moleculor mechanism of local injury therapy in improving the endometrial receptivity. Methods: There were 120 infertile patients who had 140 IVF cycles, in which 60 of them were in the local injury group (group A) and the other 60 women were in control group (group B). Scanning electron microscopy and immunohistochemistry were used to screen for the expression of pinopode, LIF and ostepontin (OPN) in the endometrium of two groups. Twenty non-pregnant women (group B2) from group B were taken to undergo local injury therapy and proceed with IVF treatment. The influence of the expression of pinopode, LIF and osteopontin before and after local injury therapy were also compared. Results: The expression of implantation related factors in group A and group B of the IVF patients were following: pinopode abundance 63.33% vs 36.67%, LIF 6.07 ± 1.33 vs 4.94 ± 2.26, OPN 6.36 ± 1.49 vs 5.28 ± 2.06. They showed more expression of pinopode and higher level of LIF, OPN in the endometrium of group A than in group B (P<0.05). The single embryo implantaion rate in group A was 27.78%, which was much higher than that in group B (14.29%, P<0.05). The expression of pinopode, LIF and OPN in group B2 before and after local injury treatment were following: pinopode abundance 10% vs 50%,LIF 4.50 ± 0.82 vs 6.33 ± 1.25, OPN 5.06 ± 0.98 vs 6.83 ± 1.46, respectively (P<0.05). A total of 140 IVF cycles were divided into the pregnancy group (62 IVF cycles) and the non-pregnancy group (78 IVF cycles) according to the outcomes of IVF-ET/ICSI. The implantation related factors expressed in the pregnancy group and the non-pregnancy group were following: pinopode abundance 54.84% vs 25.64%, LIF 6.94 ±1.03 vs 4.24±1.84, OPN 7.31±0.85 vs 4.52±1.65, respectively. These were also higher expression of the implantation related factors in the pregnancy group than in the non-pregnancy group (P<0.05). And they were correlative each other. Conclusion: Pinopode, LIF and OPN are important related factors in the implantation window. The abundant expression of pinopode and higher level of LIF, OPN in the endometrium may be closely related to the endometrial receptivity to implantation. Further more, the local injury may increase these implantation related factors and thus inhence the rate of IVF pregnancy.