宫腔镜子宫内膜微创术对子宫内膜容受性相关因子表达的影响

发布时间：2018-08-03 16:40

【摘要】：目的：通过宫腔镜对子宫内膜实施微创手术，研究术前、术后子宫内膜容受性相关因子的表达情况，从分子生物学角度分析宫腔镜子宫内膜微创术对子宫内膜容受性产生的影响，探讨其提高IVF胚胎着床率、妊娠率的临床价值，从而为反复胚胎移植失败的不孕症患者提供新的治疗方法。方法：选取2011年11月至2012年9月于广西医科大学第一附属医院生殖中心就诊的连续3次及以上IVF-ET周期治疗失败的不孕症患者20例，于种植窗期抽血测定血清雌二醇及孕酮水平，宫腔镜下观察子宫内膜形态、收集子宫内膜标本并实施子宫内膜微创术。术后第1、2个月再次实施宫腔镜子宫内膜微创术，于术后第3个月的种植窗期返院收集外周血及子宫内膜标本。比较术前、术后3月血清性激素的变化。通过HE染色，光学显微镜下观察子宫内膜的分泌情况。运用免疫组化链霉菌抗生物素蛋白-过氧化酶连接（SP）法定位及半定量检测子宫内膜ER、PR、LIF、VEGF的表达情况。术后患者再次进行体外受精-胚胎移植，随访6个月，追踪其胚胎着床、妊娠情况。实验数据以均数标准差(x±s)或率（%）表示，采用SPSS16.0软件包处理。计量资料采用t检验，计数资料采用卡方检验。检验水准为双侧，α=0.05。结果：20例反复胚胎移植失败患者实施宫腔镜子宫内膜微创术治疗，术前、术后3月血清雌、孕激素水平分别相比较（574.70±184.35VS618.91±217.85，P＞0.05；38.59±11.46VS43.60±8.85，P＞0.05），差异无统计学意义。术前、术后3月子宫内膜分泌正常者与分泌不足者分别相比较（10％VS75%，90%VS25%, P＜0.01)，差异有统计学意义。术前、术后3月子宫内膜容受性相关因子的比较：ER的表达（腺上皮0.165±0.007VS0.232±0.037，P＜0.01；间质0.085±0.020VS0.124±0.020，P＜0.01），PR的表达（腺上皮0.030±0.009VS0.079±0.018，P＜0.01；间质0.037±0.013VS0.087±0.018，P＜0.01），LIF的表达（0.204±0.015VS0.236±0.027，P＜0.01），VEGF的表达（0.155±0.025VS0.295±0.023， P＜0.01），经比较差异均有统计学意义。术后患者再次进行体外受精-胚胎移植，随访6个月着床率为33.3%，妊娠率为27.8%。结论： 1、宫腔镜子宫内膜微创术通过促进子宫内膜雌孕激素受体的表达，改善子宫内膜对卵巢性激素反应的敏感性，使子宫内膜厚度增加，分泌反应增强。 2、宫腔镜子宫内膜微创术可以增强LIF、VEGF的表达，，刺激螺旋微小血管增生，丰富子宫内膜血流，使子宫内膜向适宜胚胎粘附的状态转换。 3、宫腔镜子宫内膜微创术可以改善反复胚胎移植失败患者的子宫内膜容受性，对提高IVF胚胎植入率和临床妊娠率有重要的临床价值。
[Abstract]:Objective: to study the expression of endometrial reception-related factors before and after hysteroscopy. The effect of hysteroscopic minimally invasive endometrial surgery on endometrial receptivity was analyzed from the point of view of molecular biology, and the clinical value of hysteroscopic endometrial minimally invasive surgery on endometrial receptivity was discussed in order to improve the implantation rate and pregnancy rate of IVF embryos. This provides a new treatment for infertility patients who have failed in repeated embryo transfer. Methods: from November 2011 to September 2012, 20 infertile patients who had failed in IVF-ET cycle treatment for 3 consecutive times or more were selected from the Reproductive Center of the first affiliated Hospital of Guangxi Medical University. The serum estradiol and progesterone levels were measured during implantation window period. Endometrial morphology was observed under hysteroscopy, endometrial specimens were collected and endometrial minimally invasive procedures were performed. Hysteroscopic endometrial minimally invasive surgery was performed at the 1st and 2nd month after operation. The peripheral blood and endometrial specimens were collected at the third month after implantation. To compare the changes of serum sex hormones before and after operation. The secretion of endometrium was observed by HE staining and optical microscope. The expression of (SP) was detected by immunohistochemical staining of streptomyces biotinyl protein-peroxidase (SP). The patients underwent in vitro fertilization-embryo transfer and were followed up for 6 months to track their embryo implantation and pregnancy. The experimental data are expressed as mean standard deviation (x 卤s) or rate (%) and processed by SPSS16.0 software package. T test was used for measuring data and chi-square test was used for counting data. The test level was bilateral and 伪 -0. 05. Results 20 cases of failed repeated embryo transfer were treated with hysteroscopic minimally invasive endometrial surgery. The levels of serum estradiol and progesterone were 574.70 卤184.35VS618.91 卤217.85 (P > 0.05) and 38.59 卤8.85 卤8.85 (P > 0.05) before and 3 months after operation, respectively. There was no significant difference in serum estradiol and progesterone levels. Before and 3 months after operation, there were significant differences between normal and deficient endometrium secretion (10 vs 7590 vs 90 vs VS2590, P < 0.01). The expression of ER (0.165 卤0.007VS0.232 卤0.037) in glandular epithelium and 0.085 卤0.020VS0.124 卤0.020 in stroma (P < 0.01) were compared before and 3 months after operation. The expression of PR in glandular epithelium was 0.030 卤0.009VS0.079 卤0.018 (P < 0.01). The expression of 0.037 卤0.013VS0.087 卤0.018 0.013VS0.087 in interstitial tissue (0.204 卤0.015VS0.236 卤0.027, P < 0. 01) was significantly higher than that in control group (0.155 卤0.025VS0.295 卤0. 023, P < 0. 01). The rate of implantation and pregnancy were 33. 3 and 27. 8 respectively. Conclusion: 1. Hysteroscopic endometrial minimally invasive surgery can improve the sensitivity of endometrium to ovarian hormone by promoting the expression of estrogen and progesterone receptor and increase the thickness of endometrium. Hysteroscopic endometrial minimally invasive surgery can enhance the expression of VEGF, stimulate spiral microvascular hyperplasia, and enrich endometrial blood flow. Transition of endometrium to a state suitable for embryo adhesion. 3. Hysteroscopic endometrial minimally invasive surgery can improve endometrial receptivity in patients with repeated embryo transfer failure. It has important clinical value to improve IVF embryo implantation rate and clinical pregnancy rate.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R713.4

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