慢性子宫内膜炎与复发性流产

摘要

复发性流产(recurrent spontaneous abortion,RSA)是导致继发性不孕的重要因素之一,在育龄期女性中RSA的发病率为1％～5％.慢性子宫内膜炎(chronic endometritis,CE)是子宫内膜的持续性炎症,患者通常无明显的临床症状或仅有轻微白带与月经量增多,盆腔区域隐痛及痛经等,因此容易被忽视.组织学检查是诊断CE的金标准,CE的组织病理学诊断标准是子宫内膜间质细胞中存在浆细胞.在常规HE染色的基础上增加CD138免疫组化染色,可提高CE的检出率.新的研究发现,CE可能是导致RSA的原因之一,通过抗生素治疗CE后,可以改善RSA患者再次妊娠的结局.可见CE对于孕育方面存在一定影响,因此,应重视RSA妇女中CE的确诊和治疗.%Recurrent spontaneous abortion (RSA) is one of the most important factors of secondary infertility.The incidence of RSA in child-bearing women is 1％～5％.Chronic endometritis (CE) is a persistent inflammation of the endometrium.Patients usually have no clinical symptom,or have only mildly-increased vaginal discharge and menstrual flow,pelvic pain or dysmenorrhea.Therefore,CE is easily overlooked.Histological examination is the gold standard for the diagnosis of CE,which is characterized by the plasma cells in the endometrial stroma.On the basis of traditional HE staining,the CD138 immunohistochemistry can improve the detection rate of CE.CE is a cause of RSA,treatment by antibiotics in those CE patients can improve their pregnancy outcomes.CE has a certain influence on gestation,therefore,it is important to diagnose and treat the potential CE in those RSA patients.