反复种植失败患者慢性子宫内膜炎与外周血免疫指标的相关性研究  

Correlation between chronic endometritis and peripheral blood immune indexes in patients with repeated implantation failure

作　　者：吴纯 茹慧波 董九华 王琇 张素芝 王树松 杜丽荣 WU Chun;RU Huibo;DONG Jiuhua;WANG Xiu;ZHANG Suzhi;WANG Shusong;DU Lirong(Hebei Reproductive Health Hospital,Hebei Key Laboratory of Reproductive Medicine,Shijiazhuang 050071,China)

机构地区：[1]河北省生殖健康医院,河北省生殖医学重点实验室,石家庄050071

出　　处：《中国免疫学杂志》2025年第4期938-942,共5页Chinese Journal of Immunology

基　　金：河北省科技计划项目(223777151D,21377799D);河北省医学科学研究课题计划(20241720)。

摘　　要：目的:探讨反复种植失败(RIF)患者慢性子宫内膜炎(CE)的患病率及CE相关诊断指标与外周血免疫细胞分类的关系。方法:回顾性分析2020年1月至2021年12月就诊于河北省生殖健康医院门诊的RIF患者64例,收集患者一般信息、黄体中期宫腔镜及子宫内膜免疫组化结果、外周血NK细胞、Th1细胞、Th2细胞、Th17细胞、Treg细胞的数量和百分比,以及Th1/Th2、Th17/Treg,随访再次移植的妊娠结局。评估RIF患者宫腔镜及内膜免疫组化CD138检查对CE诊断的一致性,分析子宫内膜的慢性炎症是否与外周血免疫细胞分类存在相关关系,以及诊断CE的RIF患者再次移植的妊娠结局。结果:宫腔镜检出RIF患者CE患病率为53.12%,明显高于内膜免疫组化CD138检出CE的患病率(25.00%,P<0.05)。CE和非CE患者外周血免疫细胞数量及百分比无明显差异。CD138阳性患者经抗生素治疗后,再次移植的12周持续妊娠率、活产率高于阴性患者,差异有统计学意义(P<0.05)。结论:RIF患者选择合适的时机进行宫腔镜联合子宫内膜CD138免疫组化检查有利于提高其妊娠率,改善妊娠结局,子宫内膜浆细胞的浸润并不影响外周血免疫细胞的分类。Objective:To investigate the prevalence of chronic endometritis(CE)in patients with repeated implantation failure(RIF),and the correlation between diagnostic indexes of CE and classification of peripheral blood immune cells.Methods:A total of 64 patients with RIF who visited Outpatient of Hebei Reproductive Health Hospital from January 2020 to December 2021 were retrospectively analyzed.General information of patients,results of hysteroscopy and endometrial immunohistochemistry in the mid luteal phase,the number and percentage of NK cells,Th1 cells,Th2 cells,Th17 cells and Treg cells in peripheral blood,and Th1/Th2,Th17/Treg were collected,and the pregnancy outcome of retransplantation was followed up.To evaluate the consistency of hysteroscopy and endometrial immunohistochemistry CD138 in diagnosis of CE in RIF patients,to analyze whether chronic inflammation of endometrium was related to classification of peripheral blood immune cells,and to analyze the pregnancy outcome of patients with RIF diagnosed with CE after retransplantation.Results:Prevalence of CE in RIF patients detected by hysteroscopy was 53.12%,which was significantly higher than that detected by endometrial immunohistochemistry CD138(25.00%,P<0.05).There was no significant difference in the number and percentage of immune cells in peripheral blood between CE and non CE patients.After antibiotic treatment,the 12-week continuous pregnancy rate and live birth rate in the CD138 positive group were higher than those in negative group,with a statistically significant difference(P<0.05).Conclusion:The combination of hysteroscopy and endometrial CD138 immunohistochemistry at the right time for RIF patients is beneficial to improve their pregnancy rate and pregnancy outcome.The infiltration of endometrial plasma cells does not affect the classification of peripheral blood immune cells.

关 键 词：反复种植失败 慢性子宫内膜炎 宫腔镜 CD138 外周血免疫细胞 

分 类 号：R714.21[医药卫生—妇产科学]