子宫内膜异位症不孕与蜕膜化缺陷

doi:10.12280/gjszjk.20250111

摘要/Abstract

摘要：

子宫内膜异位症（endometriosis，EMs）是育龄期女性不孕症的主要原因之一。蜕膜化缺陷是导致EMs患者不孕的关键环节。表观遗传异常调控、孕激素抵抗和子宫内膜免疫炎性微环境紊乱是EMs患者子宫内膜蜕膜化缺陷的重要病理机制，但具体机制尚未阐明。通过梳理相关文献发现，EMs患者表观遗传异常主要通过DNA甲基化、RNA甲基化和组蛋白修饰影响蜕膜化相关基因表达；子宫内膜孕酮抵抗导致孕酮受体下游基因表达及信号通路调节异常，阻碍蜕膜化进程；子宫内膜免疫细胞、细胞因子及炎症通路的异常改变导致子宫内膜免疫炎性微环境紊乱，影响蜕膜化和胚胎植入过程，最终导致不孕。

关键词: 子宫内膜异位症, 不育, 女（雌）性, 表观基因组学, 蜕膜化缺陷, 孕激素抵抗

Abstract:

Endometriosis (EMs) is one of the major causes of infertility in women of reproductive age. Defective decidualization is a key factor contributing to EMs-related infertility. Aberrant epigenetic regulation, progesterone resistance and dysregulated endometrial immune-inflammatory microenvironment are important pathological mechanisms underlying the decidualization defects in EMs, yet the specific mechanisms remain unclear. By reviewing relevant literatures, it has been found that epigenetic abnormalities in EMs mainly affect the expressions of decidualization-related genes through DNA methylation, RNA methylation, and histone modifications. Progesterone resistance in the endometrium leads to abnormal regulation of downstream gene expression and signaling pathways of progesterone receptors, hindering the decidualization process. Moreover, abnormal changes in endometrial immune cells, cytokines, and inflammatory pathways lead to dysregulation of the endometrial immune-inflammatory microenvironment, which impair the processes of decidualization and embryo implantation, which ultimately result in EMs-related infertility.

Key words: Endometriosis, Infertility, female, Epigenomics, Defective decidualization, Progesterone resistance

邓仕婧, 张哲, 李泽, 张崴. 子宫内膜异位症不孕与蜕膜化缺陷[J]. 国际生殖健康/计划生育杂志, 2025, 44(4): 325-331.

DENG Shi-jing, ZHANG Zhe, LI Ze, ZHANG Wei. Endometriosis-Associated Infertility and Defective Decidualization[J]. Journal of International Reproductive Health/Family Planning, 2025, 44(4): 325-331.

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