慢性子宫内膜炎的内膜免疫状态

doi:10.12280/gjszjk.20220255

摘要/Abstract

摘要：

慢性子宫内膜炎（chronic endometritis，CE）是一种以病原体感染为主要病因的子宫内膜慢性、持续性炎症，与不孕及辅助生殖助孕的不良妊娠结局密切相关。虽然目前应用抗生素治疗后CE患者的妊娠结局得到较大程度改善，但仍有部分持续性CE患者的病因未明、治疗效果不佳。越来越多的研究提示CE子宫内膜的免疫状态发生改变，并可能参与子宫内膜容受性降低和不良妊娠结局的病理过程。CE的免疫状态改变主要表现为以子宫自然杀伤细胞（uterine natural killer cell，uNK细胞）、巨噬细胞为代表的固有免疫细胞和以B细胞、CD4⁺T细胞为代表的适应性免疫细胞的数量改变，CD4⁺T细胞亚群比例失调，细胞因子和趋化因子表达异常。综述CE免疫状态改变的研究进展，以期从免疫角度加深对CE的病理特征和可能影响妊娠结局的内在机制的理解。

关键词: 子宫内膜炎, 免疫细胞, 细胞因子类, 趋化因子类, 妊娠结局

Abstract:

Chronic endometritis (CE) is a chronic and persistent inflammation condition of endometrium, mainly caused by pathogen infection. It is potentially associated with infertility and poor reproductive outcomes. Although the pregnancy outcomes of some CE patients have been greatly improved after antibiotic treatment at present, the persistent CE is still a thorny problem in other patients, because the etiology of persistent CE is still unknown and the treatment effect is poor. More and more studies have suggested that the immune status of the endometrium in CE patients has changed, which is involved in the pathological process contributing to the reduced endometrial receptivity and adverse pregnancy outcomes. The changes of endometrial immune state in CE patients are mainly manifested as the number alterations of both innate immunocytes represented by uterine natural killer cells (uNK cells) and macrophages and adaptive immunocytes represented by B cells and CD4⁺T cells, the dysregulated proportion of CD4⁺T immune cell subsets and abnormal expression of cytokines and chemokines. In this artile, we reviewed the research progresses of endometrial immune state changes of CE, so as to gain further insights into the pathological characteristics and the internal mechanism that possibly affects the pregnancy outcomes of women with CE from the immune perspective.

Key words: Endometritis, Cellular immunity, Cytokines, Chemotactic factors, Pregnancy outcome

罗婉彬, 熊玉晶, 艾细雄, 古芳, 徐艳文. 慢性子宫内膜炎的内膜免疫状态[J]. 国际生殖健康/计划生育, 2022, 41(6): 499-503.

LUO Wan-bin, XIONG Yu-jing, AI Xi-xiong, GU Fang, XU Yan-wen. Endometrial Immune State of Chronic Endometritis[J]. Journal of International Reproductive Health/Family Planning, 2022, 41(6): 499-503.

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