Endometrial haemostasis and menstruation
Endometrial haemostasis and menstruation
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DOI：
10.1007/s11154-012-9226-4
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发表时间：
2012-12-01
影响因子：
8.2
通讯作者：
Kadir, Rezan A.
中科院分区：
文献类型：
--
作者：
Davies, Joanna;Kadir, Rezan A.
在正常的生理情况下，月经是一个高度调控的复杂过程，受激素的严格控制。在正常月经期间，停药引起月经。月经出血的停止是通过血小板聚集、纤维蛋白沉积和血栓形成的子宫内膜止血来实现的。局部内分泌、免疫和止血因子在分子水平上相互作用，控制子宫内膜止血。组织因子和凝血酶通过诱导凝血因子在局部停止月经出血中起关键作用。另一方面，纤溶阻止子宫腔内的凝块组织，而纤溶酶原激活剂抑制剂（PAI）和可凝血酶激活的纤溶酶抑制剂控制纤溶酶原激活剂和纤溶酶活性。子宫出血异常可由止血因子失衡引起。子宫出血最常见的异常是大量月经出血。现代研究表明，未确诊的出血性疾病，特别是血管性血友病（VWD）和血小板功能障碍，可能是HMB的潜在原因。这导致了HMB管理方法的变化。虽然并非所有HMB患者都需要进行全面的止血评估，但月经评分和出血评分可以帮助区分更可能患有出血性疾病的女性，并从实验室止血评估中获益。止血剂（氨甲环酸和DDAVP）增强全身和子宫内膜止血，对有或无出血性疾病的妇女减少经血流失有效。需要进一步的研究来提高我们对止血因子的复杂相互作用的理解，特别是在子宫内膜内。这将导致未来更有针对性的干预措施的发展，以管理异常子宫出血。
Under normal physiological circumstances menstruation is a highly regulated, complex process that is under strict hormonal control. During normal menstruation, progesterone withdrawal initiates menstruation. The cessation of menstrual bleeding is achieved by endometrial haemostasis via platelet aggregation, fibrin deposition and thrombus formation. Local endocrine, immunological and haemostatic factors interact at a molecular level to control endometrial haemostasis. Tissue factor and thrombin play a key role locally in the cessation of menstrual bleeding through instigation of the coagulation factors. On the other hand, fibrinolysis prevents clot organisation within the uterine cavity while plasminogen activator inhibitors (PAI) and thrombin-activatable fibrinolysis inhibitors control plasminogen activators and plasmin activity. Abnormalities of uterine bleeding can result from imbalance of the haemostatic factors. The most common abnormality of uterine bleeding is heavy menstrual bleeding (HMB). Modern research has shown that an undiagnosed bleeding disorder, in particular von Willebrand disease (VWD) and platelet function disorders, can be an underlying cause of HMB. This has led to a change in the approach to the management of HMB. While full haemostatic assessment is not required for all women presenting with HMB, menstrual score and bleeding score can help to discriminate women who are more likely to have a bleeding disorder and benefit from laboratory haemostatic evaluation. Haemostatic agents (tranexamic acid and DDAVP) enhance systemic and endometrial haemostasis and are effective in reducing menstrual blood loss in women with or without bleeding disorders. Further research is required to enhance our understanding of the complex interactions of haemostatic factors in general, and specifically within the endometrium. This will lead to the development of more targeted interventions for the management of abnormal uterine bleeding in the future.