国际生殖健康/计划生育杂志

国际生殖健康/计划生育 ›› 2016, Vol. 35 ›› Issue (1): 21-24.

• 论著 • 上一篇    下一篇

复发性流产患者种植窗期血清雌、孕激素水平和子宫内膜端粒酶的表达

龙娜，李瑾，蔡博宇，肖克林，高亮，李慧，易红，李晓红   

  1. 518100 广东省深圳市，暨南大学医学院附属宝安妇幼保健院生殖健康科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2016-01-15 发布日期:2016-01-15
  • 通讯作者: 龙娜

Levels of Serum Estrogen and Progesterone and Expression of Endometrial Telomerase in RSA Patients at Implantation Window

LONG Na，LI Jin，CAI Bo-yu，XIAO Ke-lin，GAO Liang，LI Hui，YI Hong，LI Xiao-hong   

  1. Department of Reproductive Health，Shenzhen Baoan Maternal and Child Health Hospital，School of Medicine, Jinan University, Shenzhen 518100，Guangdong Province，China
  • Received:1900-01-01 Revised:1900-01-01 Published:2016-01-15 Online:2016-01-15
  • Contact: LONG Na

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摘要： 目的：分析复发性流产（RSA）患者种植窗期血清雌、孕激素水平和子宫内膜端粒酶的表达，探讨RSA病理生理学机制。方法：选择2014年6月—2015年3月在深圳市宝安区妇幼保健院就诊的RSA患者32例及正常妊娠女性25例作为研究对象，采用宫腔镜检查、化学发光法、免疫组化法和实时荧光定量聚合酶链反应（PCR）法，分别检测种植窗期宫腔及子宫内膜形态、血清雌二醇（E2）、孕酮（P）水平以及子宫内膜中端粒酶含量。结果：①RSA患者中，宫腔镜下表现为差型子宫内膜者（腺体开口小或内膜血管呈点状或片状分布，严重者内膜呈鸡蛋壳状，未见明显血管及腺体）占56.3%，腺体与间质反应不同步者占40.6%；在正常妊娠组中，表现为佳型子宫内膜者（腺体开口大，极度扩张呈指环状，且内膜血管丰富呈网状分布）占84%，腺体与间质反应同步者占88%，2组比较差异有统计学意义（均P＜0.05）。②种植窗期端粒酶活性与E2/P比值呈线性相关（r=0.947 5），RSA组种植窗期子宫内膜端粒酶活性较正常妊娠组明显增强（P＜0.05）。③2组种植窗期子宫内膜端粒酶在腺上皮细胞及间质细胞均有表达，在腺上皮细胞中表达差异无统计学意义（P＞0.05），在间质细胞中RSA组较正常妊娠组增强（P＜0.05）。结论：①种植窗期宫腔镜下子宫内膜形态有助于了解及初步判定RSA患者子宫内膜容受性，为查找病因提供依据。②种植窗期子宫内膜端粒酶活性失调可能与RSA有关。③种植窗期检测血清雌、孕激素及子宫内膜端粒酶活性有助于评价RSA患者的子宫内膜容受性，从而为改善及治疗RSA提供依据。

关键词: 流产, 习惯性, 子宫内膜, 孕激素, 端粒酶, 种植窗

Abstract: Objective：To investigate the levels of sera estrogen and progesterone, and the expression level of endometrial telomerase, in those recurrent spontaneous abortion（RSA） patients in the window of implantation (WOI), so as to explore the pathophysiology of RSA. Methods：The endometrial samples were collected from 32 cases of RSA and 25 cases of normal pregnant women with the informed consent. The levels of sera estrogen and progesterone were tested by chemiluminescence. The endometrial morphology was checked by hysteroscopy. The expression level of endometrial telomerase the time of WOI was tested by immunohistochemistry and real-time PCR. Results：①56.3% patients of RAS had the so-called "bad type" endometrium under hysteroscopy, and 40.6% RSA patients had unsynchronous response in endometrial glands and stroma. In the control group, 84% women had the so-called "good type" endometrium, and 88% had synchronous response. ②There was a linear correlation between the telomerase activity in the WOI and the E2/P ratio（r=0.947 5）. The telomerase activity in the RSA group was significantly higher than that in the control group （P＜0.05）. ③The expression of telomerase was found in both the epithelial cells and the stromal cells in the WOI endometrium. There was no significant difference in the telomerase expression in the epithelial cells between two groups（P＞0.05）, while the expression in the stromal cells of the RSA group was significantly increased when compared with the control group（P＜0.05）. Conclusions：①The endometrial morphology in the WOI under hysteroscopy is helpful to understand the endometrial receptivity of RSA patients. ②The disorder of endometrial telomerase activity in the WOI may be related to RSA. ③The levels of serum estrogen and progesterone combined with the endometrial telomerase activity were used to evaluate the endometrial receptivity, which is benefit to improve the treatment of RSA.

Key words: Recurrent spontaneous abortion, Endometrium, Progesterone, Telomerase, Window of implantation