慢性子宫内膜炎:不孕患者的诊断考虑

IF 0.1 Q4 PATHOLOGY
Sandra Lee
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引用次数: 0

摘要

慢性子宫内膜炎(CE)是一个有争议的临床和病理实体。虽然浆细胞(PCs)的存在是CE最常用的诊断标准,但最低诊断标准仍然存在争议和不明确。CE的临床背景(无症状、盆腔炎、不孕症)是子宫内膜pc临床意义的重要考虑因素。在不孕症的情况下,特别是复发性着床失败(RIF)和复发性妊娠丢失(RPL), CE可能对子宫内膜容受性产生负面影响,导致更高的着床失败率。提出的病理生理学是亚临床宫内感染改变了局部炎症环境,导致正常炎症细胞向与植入失败和较差生殖结果相关的反应转变。据报道,抗生素治疗后的治愈率很高(高达90%)。描述CE对生殖结果影响的荟萃分析结果是混合的。有证据支持CE是一种可治疗的因素,治疗后可改善生殖结果,也有结果显示生殖结果没有差异。不同的CE诊断标准、纳入标准和不同研究之间的治疗方案是主要的局限性,阻碍了跨研究比较结果的能力。关于RIF和RPL设置的最佳诊断标准的结果也各不相同,一些作者建议每个大功率视场切断1个或更多CD138+ PCs,而另一些作者建议每个大功率视场切断5个或更多CD138+ PCs。有一些研究表明CE是RIF和RPL患者的负面预后因素,这可能通过抗生素治疗是可逆的。在这种临床环境中,CE的最佳诊断标准尚不明确。对于临床医生打算治疗的不孕症患者的调查,描述性诊断(表明pc的存在/数量和识别方法)是一种合理的方法。常规使用CD138免疫组化对CE的诊断价值有限。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Chronic Endometritis: Diagnostic Considerations in Patients With Infertility
Abstract Chronic endometritis (CE) is a controversial clinical and pathological entity. Although the presence of plasma cells (PCs) is the most frequently used diagnostic criterion for CE, the minimal diagnostic criteria remain controversial and undefined. The clinical setting of CE (asymptomatic, pelvic inflammatory disease, infertility) is an important consideration regarding the clinical significance of endometrial PCs. In the setting of infertility, specifically recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL), CE may have a negative impact on endometrial receptivity, resulting in higher rates of implantation failure. The proposed pathophysiology is that a subclinical intrauterine infection alters the local inflammatory milieu resulting in a shift of the normal inflammatory cell profiles toward responses associated with implantation failure and poorer reproductive outcomes. Cure rates following antibiotic treatment are reported to be high (up to 90%). The results of meta-analyses describing the effect of CE on reproductive outcomes are mixed. There is evidence supporting CE as a treatable factor with improved reproductive outcomes following treatment and there are also results showing no differences in reproductive outcomes. Variable diagnostic criteria for CE, inclusion criteria, and treatment regimens between studies are the main limitations, hampering the ability to compare results across studies. Results regarding the optimal diagnostic criteria in the setting of RIF and RPL are also variable, with some authors recommending a cutoff of 1 or more CD138+ PCs per high-power field and some recommending a cutoff of 5 or more CD138+ PCs per high-power field. There are some studies indicating CE as a negative prognostic factor in patients with RIF and RPL, which may be reversible with antibiotic treatment. The optimal diagnostic criteria for CE in this clinical setting are undefined. For the investigation of infertility patients whom clinicians intend to treat, a descriptive diagnosis (indicating the presence/number of PCs and method of identification) is a reasonable approach. Routine use of CD138 immunohistochemistry is of limited value for the diagnosis of CE.
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