难治性薄型子宫内膜的发病因素及处理策略  

Pathogenic Factors and Management Strategies of Treatment-Resistant Thin Endometrium

作　　者：王丽燕 符晓倩[1] 李华[1] 杨一华(审校) WANG Li-yan;FU Xiao-qian;LI Hua;YANG Yi-hua(Guangxi Reproductive Medicine Research Center,The First Affiliated Hospital of Guangxi Medical University,Nanning 530000,China;Yulin Maternity and Child Healthcare Hospital,Yulin 537000,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西医科大学第一附属医院广西生殖医学研究中心,南宁530000 [2]广西玉林市妇幼保健院

出　　处：《国际生殖健康／计划生育杂志》2021年第4期314-318,共5页Journal of International Reproductive Health/Family Planning

基　　金：国家自然科学基金(81871172);广西自然科学基金(2019GXNSFFA245013,2018GXNSFDA050017)。

摘　　要：子宫内膜容受性是影响胚胎种植率的主要因素之一,而子宫内膜厚度是评价子宫内膜容受性的重要指标,薄型子宫内膜(thin endometrium,TE)患者的临床妊娠结局不良。大部分TE患者在接受雌激素治疗后子宫内膜能够达到胚胎种植需要的厚度,然而部分TE患者给予超生理剂量的雌激素后仍未能达到该厚度,这种情况被称为难治性薄型子宫内膜(treatment-resistant thin endometrium,TTE)。TTE的发病机制尚不明确,目前研究认为与雌激素受体不敏感、相关因子表达异常或内膜血供不足等因素有关。TTE的主要病因包括感染、宫腔操作和血流不足等,仍存在一部分TTE患者缺乏明确的病因。目前临床上TTE的治疗主要包括药物治疗、再生医学治疗及中医治疗等。尽管目前对于TTE的治疗方法多种多样,但治疗效果仍不尽满意。综述TTE的流行病学、高危因素和治疗方法等,为临床处理提供参考。Endometrial receptivity is one of the main factors affecting embryo implantation rate,and endometrial thickness is an important index to evaluate endometrial receptivity.Patients with thin endometrium(TE)have poor clinical pregnancy outcome.The endometrium of most TE patients can reach a suitable thickness required for embryo implantation after estrogen treatment.However,some of TE patients cannot reach suitable thickness even though giving super-physiological dose of estrogen,which is called treatment-resistant thin endometrium(TTE).The pathogenesis of TTE is not clear.It is believed that the related factors of TTE are the insensitivity to estrogen receptor,abnormal expression of related factors and insufficient intimal blood supply.The main causes of TTE include infection,uterine cavity operation and insufficient blood flow.The causes of some patients with TTE are still unknown.At present,the clinical treatment of TTE mainly includes drug treatment,regenerative medicine and traditional Chinese medicine.Although there are a variety of treatment methods for TTE,the efficiency is still not satisfactory.This article reviews the epidemiology,high risk factors and treatment of TTE in order to provide reference for clinical treatment.

关 键 词：子宫内膜 受体 雌激素 血管内皮生长因子类 基质金属蛋白酶11 生殖技术 辅助 治疗 

分 类 号：R711.74[医药卫生—妇产科学]