Comparative immuno-profiling of proliferative and disordered proliferative endometrium in anovulatory abnormal uterine bleeding

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of Obstetrics and Gynaecology Research Pub Date : 2025-08-04 DOI:10.1111/jog.70032

Mishu Mangla, Seetu Palo, Poojitha Kalyani Kanikaram, P. Raja Shekar, Aparna Setty

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Abstract

Background

Anovulatory abnormal uterine bleeding (AUB) is frequently associated with prolonged unopposed estrogen exposure, resulting in histological patterns ranging from proliferative to disordered proliferative endometrium (DPE). While these entities are histologically distinguishable, their immunological microenvironments remain underexplored.

Objective

To compare the immune cell profile of proliferative and DPE in women with anovulatory AUB, focusing on key immune markers: CD4, CD8, CD56, and CD68.

Methods

wEndometrial biopsies from women diagnosed with anovulatory AUB were classified histologically as proliferative or disordered proliferative. Immunohistochemical staining was performed to quantify CD4+ helper T cells, CD8+ cytotoxic T cells, CD56+ natural killer cells, and CD64+ macrophages. Quantitative analysis was conducted using high-power field (hpf) counts, and statistical comparisons were made using appropriate non-parametric tests.

Results

A total of 73 women with AUB were analyzed, including 30 with proliferative and 43 with DPE. No statistically significant differences were observed between the two groups in age, body mass index (BMI), endometrial thickness, Pictorial Blood Assessment Chart score, or immune cell counts (CD4, CD8, CD68, CD56/hpf). Correlation analysis revealed significant positive associations among immune markers, particularly between CD4 and CD8 (r = 0.425, p < 0.001), CD8 and CD68 (r = 0.316, p = 0.006), and CD4 and CD56 (r = 0.377, p = 0.001). CD56+ cells also showed a negative correlation with BMI (r = −0.251, p = 0.032) and a positive correlation with duration of bleeding (r = 0.289, p = 0.013).

Conclusion

The local immune cell infiltration may not differ substantially between proliferative and DPE in the context of AUB. No statistically significant differences were observed between the two groups with respect to clinical parameters, endometrial thickness, or immune cell marker expression (CD4, CD8, CD68, and CD56). Positive correlations between CD4, CD8, CD68, and CD56 cells suggest coordinated immune activity within the endometrial microenvironment. Further studies with larger sample sizes and functional immune profiling are warranted to explore subtle immunological variations that may influence endometrial physiology and pathology.

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无排卵性异常子宫出血中增殖性和不规则增殖性子宫内膜的比较免疫分析

无排卵性子宫异常出血（AUB）通常与长期无对抗性雌激素暴露有关，导致从增殖性到增殖性子宫内膜紊乱（DPE）的组织学模式。虽然这些实体在组织学上是可区分的，但它们的免疫微环境仍未得到充分研究。目的比较无排卵性AUB女性增生性和DPE的免疫细胞谱，重点关注关键免疫标志物：CD4、CD8、CD56和CD68。方法对诊断为无排卵性AUB的女性进行子宫活检，组织学上分为增生性和无序增生性。免疫组化染色定量CD4+辅助性T细胞、CD8+细胞毒性T细胞、CD56+自然杀伤细胞和CD64+巨噬细胞。采用高倍场（hpf）计数进行定量分析，并采用适当的非参数检验进行统计比较。结果共分析73例AUB，其中增生性30例，DPE 43例。两组患者在年龄、体重指数（BMI）、子宫内膜厚度、血图评分、免疫细胞计数（CD4、CD8、CD68、CD56/hpf）方面均无统计学差异。相关分析显示免疫标志物之间存在显著正相关，特别是CD4和CD8 （r = 0.425, p < 0.001）、CD8和CD68 （r = 0.316, p = 0.006）、CD4和CD56 （r = 0.377, p = 0.001）。CD56+细胞与BMI呈负相关（r = - 0.251, p = 0.032），与出血时间呈正相关（r = 0.289, p = 0.013）。结论在AUB情况下，增殖性与DPE的局部免疫细胞浸润无明显差异。两组在临床参数、子宫内膜厚度或免疫细胞标志物（CD4、CD8、CD68和CD56）表达方面无统计学差异。CD4、CD8、CD68和CD56细胞之间的正相关表明子宫内膜微环境中存在协调的免疫活动。进一步的研究需要更大的样本量和功能免疫分析来探索可能影响子宫内膜生理和病理的细微免疫变异。

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来源期刊

Journal of Obstetrics and Gynaecology Research 医学-妇产科学

CiteScore

3.10

自引率

0.00%

发文量

376

审稿时长

3-6 weeks

期刊介绍： The Journal of Obstetrics and Gynaecology Research is the official Journal of the Asia and Oceania Federation of Obstetrics and Gynecology and of the Japan Society of Obstetrics and Gynecology, and aims to provide a medium for the publication of articles in the fields of obstetrics and gynecology. The Journal publishes original research articles, case reports, review articles and letters to the editor. The Journal will give publication priority to original research articles over case reports. Accepted papers become the exclusive licence of the Journal. Manuscripts are peer reviewed by at least two referees and/or Associate Editors expert in the field of the submitted paper.