Effects of hormone replacement therapy on endometrial hormone concentrations and progesterone receptor expression in recurrent pregnancy loss: a self-controlled study
Effects of hormone replacement therapy on endometrial hormone concentrations and progesterone receptor expression in recurrent pregnancy loss: a self-controlled study
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激素替代疗法对复发性流产子宫内膜激素浓度和孕酮受体表达的影响：一项自我对照研究
DOI：
10.1080/14767058.2019.1638357
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发表时间：
2019-08-07
影响因子：
1.8
通讯作者：
Zhou，Canquan
中科院分区：
文献类型：
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作者：
Zhang，Limei;Zhang，Yingying;Zhou，Canquan
摘要 目的 探讨子宫内膜准备方法、自然周期（NC）和激素替代疗法（HRT）对复发性流产（RPL）患者子宫内膜激素状况的差异影响。方法 纳入42例RPL患者，进行自我对照试验，比较NC与HRT对同一患者的有效性。分别在 NC 和 HRT 中测量血清和子宫内膜组织中的雌二醇 (E2) 和孕酮 (P) 水平。同时，还比较了NC和HRT周期在接受窗口期间子宫内膜孕酮受体A（PRA）和孕酮受体B（PRB）的表达水平。所有统计分析均使用 GraphPad Prism 5 进行，对受试者的数据进行平均，并通过配对样本 t 检验检验显着性。结果 与 NC 条件相比，激素替代轻度降低血清 E2 和 P 水平（平均分别为 0.9 倍和 0.8 倍），显着升高子宫内膜 E2 和 P（平均分别为 2.1 倍和 14.5 倍），并降低子宫内膜 E2/P 比值（平均 0.34 倍）。然而，未发现血清和子宫内膜激素浓度之间存在相关性。此外，HRT 和 NC 条件下基质细胞和腺细胞的 PRA/PRB 比率相当，尽管与 NC 相比，HRT 使基质 PRA 表达略有升高（1.63±0.96 vs 1.18±0.99，p =.0173）。结论 对于RPL患者，HRT子宫内膜准备效果与NC相似或略优于NC。
Abstract Aim To investigate the differential effects of endometrial preparation approaches, natural cycle (NC) and hormone replacement therapy (HRT), on the endometrial hormone conditions in patients with recurrent pregnancy loss (RPL). Methods 42 RPL patients were recruited, and a self-controlled trial was conducted to compare the effectiveness of NC to HRT on the same patient. The estradiol (E2) and progesterone (P) levels in both serum and endometrial tissue were measured in NC and HRT, respectively. Meanwhile, the expression levels of endometrial progesterone receptor A (PRA) and progesterone receptor B (PRB) were also compared between NC and HRT cycles during the window of receptivity. All statistical analyses were performed using GraphPad Prism 5, and data were averaged across subjects and tested for significance by pair-samples t-test. Results Hormone replacement slightly decreased serum E2 and P levels (0.9- and 0.8-fold in average, respectively), significantly elevated endometrial E2 and P (2.1- and 14.5-fold in average, respectively), and reduced endometrial E2/P ratio (0.34-fold in average) compared to the NC condition. However, no correlation was found between serum and endometrial hormone concentrations. Further, the PRA/PRB ratios of both stromal and glandular cells were comparable between HRT and NC conditions, even though stromal PRA expression was slightly elevated by HRT compared to NC (1.63±0.96 vs 1.18±0.99, p =.0173). Conclusion The effects of HRT for endometrial preparation are similar or slightly superior to NC in RPL patients.