原发性不孕症子宫内膜组织学诊断分级及其临床意义

目的探讨原发性不孕症子宫内膜组织学诊断分级及其与临床治疗的关系。方法对112例原发性不孕症患者月经来潮6h内的子宫内膜进行组织学观察,并进行分级诊断,即分为增生和分泌反应两类,再各以其反应强度由弱到强分为Ⅰ～Ⅲ级。同时筛选16例有生育史的子宫内膜标本作为对照组。结果原发性不孕症组及对照组分泌反应类显著高于增生反应类(P均<0．01)。不孕症组分泌反应Ⅲ级显著低于分泌反应Ⅰ级与Ⅱ级之和(P<0．01),而对照组分泌反应Ⅲ级则高于分泌反应Ⅰ级与Ⅱ级之和(P<0．05)。原发性不孕症组分泌反应Ⅲ级显著低于对照组(P<0． 01),治疗以激素为主。结论原发性不孕症子宫内膜组织学分级对指导临床治疗有重要意义。

Histological grading of endometrium in diagnosis of primary infertility and its clinical significance

Objective To study the histological grading of endometrium of primary infertility and its correlation to the efficacy of clinical treatment. Methods 112 patients with primary infertility were enrolled in this study. The endometrium tissue samples from them with menstruating less than 8 hours were proposed for diagnostic classification with a proliferative reaction type and a secretory type. Based on the degree of the reaaction, each type was subdivided into three grades (Ⅰ-Ⅲ). And 16 endometrium samples with history of fertility were enrolled as a control group in this study. Results In the primary infertility group and the control group, the numbers of secretory reaction type were higher than proliferative reaction type (P<0.01), respectively. In the primary infertility group, the number of grade Ⅲ secretory reaction was significantly lower than the cumulative of grade Ⅰ plus grade Ⅱ secretory reaction ( P <0.01). And in the control group, the number of grade Ⅲ secretory reaction was higher than the cumulative of grade I plus grade Ⅱ secretory reaction ( P <0.05). In the primary infertility group, the number of grade Ⅲ secretory reaction was significantly lower than that in the control group ( P <0.01). Hormone was the leading selection for treatment. Conclusion Histological grading may play an important role for treatment of primary infertility.