子宫内膜着床窗期血管生成状态及胞饮突表达对胚胎着床的影响  

The effect of the angiogenesis and pinopodes expression in the endometrium of implantation window on embryo implantation.

作　　者：冯苗 李素春 潘萍 吴穗妹 刘标英 苏耘 

机构地区：[1]广东省计划生育专科医院,广东广州510600

出　　处：《中国实用妇科与产科杂志》2010年第7期525-529,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：广东省科技厅科技计划项目(2007B0305010)

摘　　要：目的探讨子宫内膜着床窗期血管生成状态及胞饮突表达对胚胎着床的影响。方法选择2007年5月至2009年3月在广东省计划生育专科医院就诊的体外受精-胚胎移植(IVF-ET)失败患者53例作为着床失败组,正常已生育妇女18例作为正常生育组。比较两组着床窗期血清雌二醇(E2)、孕酮(P)的水平;以血管内皮特异标记物CD34抗体标记微血管内皮细胞并测定微血管密度(MVD)计数,免疫组织化学技术检测子宫内膜雌激素受体(ER)、孕激素受体(PR)、血管内皮生长因子(vascular endothelial growth factor,VEGF)的表达;扫描电镜观察胞饮突的形态及数量。结果着床失败组MVD为(9.52±1.34)条/高倍视野(HP),正常生育组MVD为(21.71±3.97)条/HP,两组差异有统计学意义(P<0.05)。两组血清E2、P水平及子宫内膜ER、PR的表达强度比较差异均无统计学意义(P>0.05),着床失败组着床窗期子宫内膜CD34及VEGF的表达强度均明显低于正常生育组(P<0.05)。子宫内膜MVD计数与内膜腺上皮VEGF的表达存在正相关关系(r=0.916,P<0.01)。着床失败组子宫内膜胞饮突所占面积不足,且胞饮突的发育明显滞后于正常生育组(P<0.01)。子宫内膜MVD计数与发育完全的胞饮突数量呈正相关(r=0.821,P<0.01)。结论 (1)VEGF调控子宫内膜血管生成,促进胚胎着床。(2)IVF-ET失败妇女着床窗期存在血管生成不良和胞饮突表达不足,可能是导致其着床失败的原因之一。Objective To investigate the angiogenesis and pinopodes expression in the endometrium of implantation window on embryo implantation. Methods 53 women with failure of IVF-ET were defined as the implantation failure group, while 18 fertile women were defined as the normal group. All patients were examined in the implantation window, including the level of serum E2 and P, the expression of vascular endothelial specific marker CD34 and MVD count, the expression of ER, PR and VEGF in the endometrium tissue by immunohistochemistry technique, and pinopodes expression by scanning electron microscope. Results The MVD in the normal group was （21.71 ± 3.97） slip / HP, significantly more than that in the implantation failure group （9. 52 ± 1.34） slip / HP（P 〈 0. 05）. There were no differences of the serum E2 and P level and the ER and PR expression in the endometrium between two groups. The expression of CD34 and VEGF in the endometrium was significantly lower in the implantation failure group than that in the normal group （ P 〈 0. 05 ）. The MVD count was positively correlated with VEGF expression of endometrial gland （r= 0. 916, P 〈 0. 01 ）. Compared with the normal group, the implantation failure group showed deficient pinopodes coverage and the delayed pinopodes development（ P 〈 0. 01 ）. The MVD count was positively correlated with the number of fully developed pinopodes （ r = 0. 821, P 〈 0. 01 ）. Conclusion （ 1 ） VEGF regulates the angiogenesis of the endometrium, and may play an important role in the process of implantation. （2）The deficiency of angiogenesis and lower expression of pinopodes in implantation window may be one of the cause of failure in IVF-ET cycle.

关 键 词：着床失败 子宫内膜 微血管密度 胞饮突 

分 类 号：R71[医药卫生—妇产科学]