Hydrosalpinges 输卵管积液

分类:医学文献 52 0

Evidence accumulated previously suggests that either unilateral or bilateral hydrosalpinges may exert deleterious effects on IVF cycle outcome (1).

前研究发现,单侧或双侧输卵管积液可能对试管周期结果产生不利影响(1)。

A meta-analysis encompassing 1004 patients with hydrosalpinges and 4588 control patients with tubal factor infertility but without hydrosalpinges in 14 studies showed significant decreases in pregnancy, implantation, and delivery rates in the hydrosalpinx groups (OR 0.64, 0.63, 0.58, respectively) (2).

一项元分析整合了14项研究数据,对比了1004名输卵管积液患者和4588名输管卵因素不孕症但没有积液的对照患者后发现,输卵管积液组在妊娠率、植入率和分娩率方面显著低于对照组(比值比分别为0.64、0.63和0.58)(2)。

A variety of hypotheses have been proposed to explain the effect. The accumulation of fluid of any source within the endometrial cavity has been shown to impair embryonic implantation (3). In addition, hydrosalpinx fluid may have a direct embryotoxic effect and may also inhibit fertilization (4). This deleterious effect may be mediated by the presence of inflammatory cytokines present with hydrosalpinx fluid (5). Others have shown that the endometrial of women with hydrosalpinges expressed significantly less αvβ3 integrin, a presumptive marker of endometrial receptivity, than fertile controls (6). Implantation may also be inhibited by diminished endometrial expression of HOXA-10, purported to be a regulator of endometrial receptivity, in the presence of hydrosalpinx fluid (7).

研究人员对这个结果提出了各种解说。不管宫腔内的液体来源于何处,积液的存在都会影响胚胎植入(3)。此外,输卵管积水可能对胚胎有直接的毒性作用,也可能抑制受精(4)。这种有害作用可能是由输卵管积液中存在的炎性细胞因子造成的(5)。一些研究人员发现,有输卵管积液的女性子宫内膜表达的αvβ3整合素(其被认为是一种子宫内膜容受性标志物)显著低于能可育的对照组(6)。在存在输卵管积液的情况下,子宫内膜表达的HOXA-10减少,HOXA-10被认为是子宫内膜容受性的调控因子,它的减少可能会抑制胚胎着床(7)。

If retrograde flow of hydrosalpinx fluid is the cause of this deleterious effect, then prophylactic salpingectomy or tubal occlusion performed prior to embryo transfer should enhance outcomes. On the other hand, if damage from this fluid to the uterine environment is irreversible, then such surgery would have no beneficial effect. Strandell and colleagues published the results of a prospective randomized trial of 192 patients with hydrosalpinges who underwent salpingectomy or no intervention prior to embryo transfer and also began an actual treatment cycle (8). The salpingectomy group experienced significantly increased delivery rates with a trend towards increased clinical pregnancy rates.

如果输卵管积液逆流是导致这种有害结果的原因,那么在胚胎移植前进行预防性输卵管切除术或输卵管堵塞术应该会改良结果。此外,如果积液对宫腔的损害是不可逆的,那么做输卵管手术便不会带来任何益处。Strandell及其同事发表了一项前瞻性随机试验报告,该试验对象为192名输卵管积液患者,这些患者在胚胎移植前做了输卵管切除术或未进行手术干预,并开始了一个移植周期(8)。他们发现输卵管切除术组的分娩率显著增加,且临床妊娠率也呈增加趋势。

The way in which salpingectomy acts to improve IVF outcome has not been shown conclusively. Bildirici et al. proposed that salpingectomy may restore αvβ3 integrin expression, thus enhancing endometrial receptivity (9). Others have demonstrated a reduction of endometrial lymphocyte clusters after salpingectomy, purportedly reflecting suppression of natural killer cell activation (10). Seli and coworkers reported that endometrial leukemia inhibitory factor expression, a proposed marker for endometrial receptivity, is suppressed in the presence of a hydrosalpinx but increased after tubal resection (11).

输卵管切除术改善试管结果的机制尚未得到最终证实。Bildirici等人认为输卵管切除术可以恢复αvβ3整合素的表达,从而增加子宫内膜容受性(9)。其他人员已经证实输卵管切除术后子宫内膜淋巴细胞簇减少,有人认为这反映了自然杀伤细胞活化后的抑制反应(10)。Seli和其同事发现,子宫内膜白血病抑制因子的表达(被认为是子宫内膜容受性标志物)在输卵管积液环境下会受到抑制,但在输卵管切除术后会增加(11)。

References

参考文献

1. Murray D, Sagoskin A, Widra E, Levy M. The adverse effect of hydrosalpinges on in vitro fertilization pregnancy rate and the benefit of surgical correction. Fertil Steril 1998;69:41-5.

2. Camus E, Poncelet C, Goffinet F, et al. Pregnancy rates after in vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies Hum Reprod 1999;14:1243-9.

3. Mansour R, Aboulghar M, Serour G, Raafat R. Fluid accumulation of the uterine cavity before embryo transfer: a possible hinderance for implantation. J In Vitro Fertil Embryo Transf 1991;8:157-9.

4. Arrighi C, Lucas H, El-Mowafi D, Campana A, Chardonnens D. Effects of human hydrosalpinx fluid on in-vitro murine fertilization. Hum Reprod 2001;16:676-82.

5. Strandell A, Twinburn J, Wallin A. The presence of cytokines and growth factors in hydrosalpingeal fliud. J Assist Reprod Genet 2004;21:241-7.

6. Meyer W, Castelbaum A, Somkuti S, et al. Hydrosalpinges adversely affect markers of endometrial receptivity. Hum Reprod 1997;12:1393-8.

7. Daftary G, Taylor H. Hydrosalpinx fluid diminishes endometrial HOXA 10 expression. Fertil Steril 2002;78:577-80.

8. Strandell A, Lindhard A, Waldenstrom U, et al. Hydrosalpinx and IVF outcome: a prospective randomized multicentre trial in Scandinavia on salpingectomy prior to IVF. Hum Reprod 1999;14:2762-9.

9. Bildirici I, Bukulmez O, Ensari A, YaralI H, Guregan T. A prospective evaluation of the effect of salpingectomy on endometrial receptivity in cases of women with communication hydrosalpinges. Hum Reprod 2001;96:2422-6.

10. Ito C, Ito M, Itakura A, et al. A prospective evaluation of the effect of salpingectomy on endometrial lymphocyte clusters in patients with hydrosalpinges. Fertil Steril 2004;80:149-53.

11. Seli E, Kagiski U, Lakniak H, et al. Removal of hydrosalpinges increases endometrial leukemia inhibitory factor expression at the time of the implantation window. Hum Reprod 2005;20:3012-17.

上一篇: 下一篇:
展开更多
问题留言

loading...

问题留言

loading...