早期复发性流产与亚临床性子宫内膜炎相关性及可能机制

目的:探讨早期复发性流产与子宫内膜炎之间的相关性及可能的分子机制。方法:24例早期复发性流产(early recurrent miscarriage,ERM)妇女种植窗期子宫内膜(ERM组)行透射电镜观察,并通过免疫组织化学分析黏蛋白-1(mucin-1,MUC-1)、缺氧诱导因子-1α(hypoxia induced fac-tor-1α,HIF-1α)的表达。结果:ERM组上皮细胞及间质细胞炎性细胞浸润率为79.2%,并有细胞坏死及细胞表面微绒毛破坏表现,因男方因素接受ICSI的正常妇女种植窗期子宫内膜(对照组,n=22)未见明显炎性细胞浸润;同时通过免疫组织化学分析,ERM组MUC-1表达异常下降,HIF-1α表达增强。结论:ERM妇女存在亚临床性子宫内膜炎可能。子宫内膜MUC-1表达下降可能与亚临床性子宫内膜炎相关,其表达增强可能是造成子宫内膜炎性细胞浸润的原因之一,HIF-1α强表达提示子宫内膜缺血缺氧,证实子宫内膜慢性缺血缺氧可能是造成ERM的原因之一。

Research on Relationship between Early Recurrent Miscarriage and Subclinical Endometritis and the Possible Mechanism

Objective: To explore the relationship between early recurrent miscarriage and subclinical endometritis, and to approach the possible mechanism. Methods: A total of 24 women suffered with 3 or more recurrent early miscarriages (ERM group) were selected. Endometrium was obtained on the day of LH+7 or LH+8, transmission electron microscope was used to observe the ultra-structure, and the expression of MUC-1 and HIF-lα were analyzed by immunohistochemistry. Results: In early recurrent miscarriage group, inflammatory cell infiltrate rate was 79.2%. Necrosis and microvilli destroy rate was 12.9%. No obvious inflammatory cell infiltrate was found in control group. MUC-1 was expressed weaker in ERM group while HIF-lα stained stronger than those of nomal women with their husband's reason (control group). Conclusion: Early recurrent miscarriage women may have subclinical endometritis. Low expression of MUC-1 may have relationship with subclinical endometritis, chronical anoxaemia was the possible reason of endometritis, and may via HIF-lα pathway.