子宫结合带厚度对辅助生殖技术妊娠结局的预测作用
|
摘要
虽然目前辅助生殖技术的发展日趋完善,常规IVF助孕的妊娠率可达到50%～60%,但仍有不少患者出现移植失败的情况。如何预测助孕患者的妊娠结局并及时处理是一个亟需解决的问题。子宫结合带作为子宫内膜与子宫外肌层之间的解剖结构,研究发现子宫结合带与子宫内膜有着共同的组织来源,功能上具有一定的相似性,例如二者的厚度均随激素水平的变化发生相应的变化。子宫结合带在维持经血排出、精子输送以及胚胎着床等生理过程中发挥重要作用。其厚度和形态的异常改变有可能导致子宫蠕动波的频率、强度及方向改变,从而使精子的运输及胚胎着床受阻,最终导致妊娠的失败。但子宫结合带厚度可否作为预测辅助生殖技术助孕结局的指标尚需进一步研究。
At present,the development of assisted reproductive technology is getting better and better.The pregnancy rate of conventional IVF can reach to 50%-60%.However,there are still many patients with transplant failures.How to predict the outcomes of ART patients and timely treatment is an urgent problem to be solved.The uterine junctional zone is an anatomical structure between the endometrium and the extrauterine muscle layer.Researchers found that the uterine junctional zone has a common tissue source with the endometrium,and has a certain similarity in function.For example,the changes of thickness of both of them were correspondingly with the hormone levels.The uterine junctional zone plays the important roles in maintaining physiological functions such as menstrual discharge,sperm delivery,and embryo implantation.Abnormal changes in the thickness and morphology of the uterine junctional zone may cause changes in the frequency,intensity,and direction of the uterine peristaltic waves,thereby impeding sperm transport and embryo implantation.Eventually,the abnormal changes lead to pregnancy failure.Whether the thickness of the uterus junctional zone can be used as a predictor for the outcome of assisted reproductive technology should be further investigated.
At present,the development of assisted reproductive technology is getting better and better.The pregnancy rate of conventional IVF can reach to 50%-60%.However,there are still many patients with transplant failures.How to predict the outcomes of ART patients and timely treatment is an urgent problem to be solved.The uterine junctional zone is an anatomical structure between the endometrium and the extrauterine muscle layer.Researchers found that the uterine junctional zone has a common tissue source with the endometrium,and has a certain similarity in function.For example,the changes of thickness of both of them were correspondingly with the hormone levels.The uterine junctional zone plays the important roles in maintaining physiological functions such as menstrual discharge,sperm delivery,and embryo implantation.Abnormal changes in the thickness and morphology of the uterine junctional zone may cause changes in the frequency,intensity,and direction of the uterine peristaltic waves,thereby impeding sperm transport and embryo implantation.Eventually,the abnormal changes lead to pregnancy failure.Whether the thickness of the uterus junctional zone can be used as a predictor for the outcome of assisted reproductive technology should be further investigated.
引文
[1]Hricak H,Alpers C,Crooks LE,et al.Magnetic resonance imaging of the female pelvis:initial experience[J].AJR Am JRoentgenol,1983,141:1119-1128.
[2]Boodhwani M,Sellke FW.Myometrium:another candidate for cell-based myocardial angiogenesis[J].Am J Physiol Heart Circ Physiol,2006,291:H2039-H2040.
[3]雷建明,尚华,耿左军,等.3.0TMI评估正常子宫肌层的年龄差异[J].河北医药,2016,38:3548-3550.
[4]Meylaerts LJ,Wijnen L,Ombelet W,et al.Uterine junctional zone thickness in infertile women evaluated by MRI[J].JMagn Reson Imaging,2017,45:926-936.
[5]刘竞艳,万业达,齐扬,等.正常子宫体肌层低场磁共振T2wI信号表现及随月经周期变化的研究[J].中国临床影像学杂志,2013,24:130-132.
[6]Meylaerts LJ,Wijnen L,Grieten M,et al.Junctional zone thickness in young nulliparous women according to menstrual cycle and hormonal contraception use[J/OL].Reprod Biomed Online,2017,34:212-220.
[7]刘竞艳,万业达.子宫结合带正常MRI表现的组织学基础[J].国际医学放射学杂志,2008,31:257-260.
[8]Brosens JJ,Barker FG,de Souza NM.Myometrial zonal differentiation and uterine junctional zone hyperplasia in the non-pregnant uterus[J].Hum Reprod Update,1998,4:496-502.
[9]杨媛媛,吕富荣.电影磁共振成像技术观察子宫蠕动的研究进展[J].磁共振成像,2017,8:547-550.
[10]刘燕.OTR、PKCβ及CPI-17在子宫腺肌病患者子宫结合带中的表达及意义[D].郑州大学,2017.
[11]张琪,顾茵茵,毛羽,等.动态磁共振在研究子宫内膜蠕动方面的应用[J].中国CT和MRI杂志,2016,14:71-74.
[12]张译升,何冰.子宫收缩与胚胎着床关系及子宫收缩抑制药物的研究概况[J].中国临床新医学,2017,10:1117-1120.
[13]潘荣,刘晓娟,于玲,等.子宫内膜厚度与新鲜IVF-ET术后异位妊娠相关性研究[J].生殖医学杂志,2018,27:55-59.
[14]Gianaroli L,Gordts S,D’Angelo A,et al.Effect of inner myometrium fibroid on reproductive outcome after IVF[J/OL].Reprod Biomed Online,2005,10:473-477.
[15]吴泽璇,张清学.子宫内膜异位症和子宫腺肌病患者降调节促排卵方案的选择[J].生殖医学杂志,2017,26:1083-1087.
[16]Agostinho L,Cruz R,Osório F,et al.MRI for adenomyosis:a pictorial review[J].Insights Imaging,2017,8:549-556.
[17]Sofic A,Husic-Selimovic A,Carovac A,et al.The significance of MRI evaluation of the uterine junctional zone in the early diagnosis of adenomyosis[J].Acta Inform Med,2016,24:103-106.
[18]耿杰,孔宪超.子宫结合带的结构和功能与子宫内膜异位性疾病的关系[J].中国医师杂志,2018,20:1273-1275.
[19]Ibrahim MG,Sillem M,Plendl J,et al.Myofibroblasts are evidence of chronic tissue microtrauma at the endometrialmyometrial junctional zone in uteri with adenomyosis[J].Reprod Sci,2017,24:1410-1418.
[20]Huang M,Li X,Guo P,et al.The abnormal expression of oxytocin receptors in the uterine junctional zone in women with endometrios[J].Reprod Biol Endocrinol,2017,15:1.
[21]刘燕,孔红霞,周俊杰,等.子宫腺肌病患者子宫结合带组织中OTR、PKCβ、CPI-17表达观察[J].山东医药,2017,57:83-85.
[22]Lesny P,Killick SR,Tetlow RL,et al.Ultrasound evaluation of the uterine zonal anatomy during in-vitro fertilization and embryo transfer[J].Hum Reprod,1999,14:1593-1598.
[23]Kunz G,Beil D.Characterization of the uterine junctional zone prior to IVF/ICSI:an observational study[J].Arch Gynecol Obstet,2010,281:945-953.
[24]Maubon A,Faury A,Kapella M,et al.Uterine junctional zone at magnetic resonance imaging:apredictor of in vitro fertilization implantation failure[J].J Obstet Gynaecol Res,2010,36:611-618.
[25]Piver P.Uterine factors limiting ART coverage[J].J Gynecol Obstet Biol Reprod(Paris),2005,34(7Pt 2):5S30-5S33.
[26]黄苗苗,何晔,李绪清,等.缩宫素受体在子宫内膜异位症子宫结合带中的表达[J].中华生殖与避孕,2017,37:203-207
[27]Maged AM,Ramzy AM,Ghar MA,et al.3D ultrasound assessment of endometrial junctional zone anatomy as a predictor of the outcome of ICSI cycles[J].Eur J Obstet Gynecol Reprod Biol,2017,212:160-165.
[28]何莹,任青,程忠平.子宫内膜-肌层结合带的结构、功能与子宫腺肌病的关系[J].医学综述,2016,22:2317-2320.
[29]王萍,徐萍,黎规典.育龄女性正常子宫周期性磁共振成像表现[J].临床医学工程,2015,22:1276-1280.
[30]He YL,Ding N,Li Y,et al.Cyclic changes of the junctional zone on 3T MRI images in young and middle-aged females during the menstrual cycle[J].Clin Radiol,2016,71:341-348.
[31]Dashottar S,Singh AK,Debnath J,et al.Comparative analysis of changes in MR imaging of pre and post intrauterine progesterone implants in adenomyosis cases[J].Med J Armed Forces India,2015,71:145-151.
[32]Meylaerts LJ,Wijnen L,Ombelet W,et al.Uterine junctional zone thickness in infertile women evaluated by MRI[J].JMagn Reson Imaging,2017,45:926-936.
[33]Rasmussen CK,Glavind L,Madsen LD,et al.Repeatability of junctional zone measurements using 3-dimensional transvaginal sonography in healthy fertile women[J].JUltrasound Med,2016,35:1497-1508.
[2]Boodhwani M,Sellke FW.Myometrium:another candidate for cell-based myocardial angiogenesis[J].Am J Physiol Heart Circ Physiol,2006,291:H2039-H2040.
[3]雷建明,尚华,耿左军,等.3.0TMI评估正常子宫肌层的年龄差异[J].河北医药,2016,38:3548-3550.
[4]Meylaerts LJ,Wijnen L,Ombelet W,et al.Uterine junctional zone thickness in infertile women evaluated by MRI[J].JMagn Reson Imaging,2017,45:926-936.
[5]刘竞艳,万业达,齐扬,等.正常子宫体肌层低场磁共振T2wI信号表现及随月经周期变化的研究[J].中国临床影像学杂志,2013,24:130-132.
[6]Meylaerts LJ,Wijnen L,Grieten M,et al.Junctional zone thickness in young nulliparous women according to menstrual cycle and hormonal contraception use[J/OL].Reprod Biomed Online,2017,34:212-220.
[7]刘竞艳,万业达.子宫结合带正常MRI表现的组织学基础[J].国际医学放射学杂志,2008,31:257-260.
[8]Brosens JJ,Barker FG,de Souza NM.Myometrial zonal differentiation and uterine junctional zone hyperplasia in the non-pregnant uterus[J].Hum Reprod Update,1998,4:496-502.
[9]杨媛媛,吕富荣.电影磁共振成像技术观察子宫蠕动的研究进展[J].磁共振成像,2017,8:547-550.
[10]刘燕.OTR、PKCβ及CPI-17在子宫腺肌病患者子宫结合带中的表达及意义[D].郑州大学,2017.
[11]张琪,顾茵茵,毛羽,等.动态磁共振在研究子宫内膜蠕动方面的应用[J].中国CT和MRI杂志,2016,14:71-74.
[12]张译升,何冰.子宫收缩与胚胎着床关系及子宫收缩抑制药物的研究概况[J].中国临床新医学,2017,10:1117-1120.
[13]潘荣,刘晓娟,于玲,等.子宫内膜厚度与新鲜IVF-ET术后异位妊娠相关性研究[J].生殖医学杂志,2018,27:55-59.
[14]Gianaroli L,Gordts S,D’Angelo A,et al.Effect of inner myometrium fibroid on reproductive outcome after IVF[J/OL].Reprod Biomed Online,2005,10:473-477.
[15]吴泽璇,张清学.子宫内膜异位症和子宫腺肌病患者降调节促排卵方案的选择[J].生殖医学杂志,2017,26:1083-1087.
[16]Agostinho L,Cruz R,Osório F,et al.MRI for adenomyosis:a pictorial review[J].Insights Imaging,2017,8:549-556.
[17]Sofic A,Husic-Selimovic A,Carovac A,et al.The significance of MRI evaluation of the uterine junctional zone in the early diagnosis of adenomyosis[J].Acta Inform Med,2016,24:103-106.
[18]耿杰,孔宪超.子宫结合带的结构和功能与子宫内膜异位性疾病的关系[J].中国医师杂志,2018,20:1273-1275.
[19]Ibrahim MG,Sillem M,Plendl J,et al.Myofibroblasts are evidence of chronic tissue microtrauma at the endometrialmyometrial junctional zone in uteri with adenomyosis[J].Reprod Sci,2017,24:1410-1418.
[20]Huang M,Li X,Guo P,et al.The abnormal expression of oxytocin receptors in the uterine junctional zone in women with endometrios[J].Reprod Biol Endocrinol,2017,15:1.
[21]刘燕,孔红霞,周俊杰,等.子宫腺肌病患者子宫结合带组织中OTR、PKCβ、CPI-17表达观察[J].山东医药,2017,57:83-85.
[22]Lesny P,Killick SR,Tetlow RL,et al.Ultrasound evaluation of the uterine zonal anatomy during in-vitro fertilization and embryo transfer[J].Hum Reprod,1999,14:1593-1598.
[23]Kunz G,Beil D.Characterization of the uterine junctional zone prior to IVF/ICSI:an observational study[J].Arch Gynecol Obstet,2010,281:945-953.
[24]Maubon A,Faury A,Kapella M,et al.Uterine junctional zone at magnetic resonance imaging:apredictor of in vitro fertilization implantation failure[J].J Obstet Gynaecol Res,2010,36:611-618.
[25]Piver P.Uterine factors limiting ART coverage[J].J Gynecol Obstet Biol Reprod(Paris),2005,34(7Pt 2):5S30-5S33.
[26]黄苗苗,何晔,李绪清,等.缩宫素受体在子宫内膜异位症子宫结合带中的表达[J].中华生殖与避孕,2017,37:203-207
[27]Maged AM,Ramzy AM,Ghar MA,et al.3D ultrasound assessment of endometrial junctional zone anatomy as a predictor of the outcome of ICSI cycles[J].Eur J Obstet Gynecol Reprod Biol,2017,212:160-165.
[28]何莹,任青,程忠平.子宫内膜-肌层结合带的结构、功能与子宫腺肌病的关系[J].医学综述,2016,22:2317-2320.
[29]王萍,徐萍,黎规典.育龄女性正常子宫周期性磁共振成像表现[J].临床医学工程,2015,22:1276-1280.
[30]He YL,Ding N,Li Y,et al.Cyclic changes of the junctional zone on 3T MRI images in young and middle-aged females during the menstrual cycle[J].Clin Radiol,2016,71:341-348.
[31]Dashottar S,Singh AK,Debnath J,et al.Comparative analysis of changes in MR imaging of pre and post intrauterine progesterone implants in adenomyosis cases[J].Med J Armed Forces India,2015,71:145-151.
[32]Meylaerts LJ,Wijnen L,Ombelet W,et al.Uterine junctional zone thickness in infertile women evaluated by MRI[J].JMagn Reson Imaging,2017,45:926-936.
[33]Rasmussen CK,Glavind L,Madsen LD,et al.Repeatability of junctional zone measurements using 3-dimensional transvaginal sonography in healthy fertile women[J].JUltrasound Med,2016,35:1497-1508.