子宮内膜症における子宮腔内細菌叢の同定と細菌環境が不妊医療に及ぼす影響

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We examined the hypothesis that antibiotic treatment with and without gonadotropin releasing hormone agonist (GnRHa) may decrease intrauterine infection with consequent decrease in tissue inflammation, cell proliferation, angiogenesis and occurrence of chronic endometritis in women with endometriosis. We performed a prospective non-randomized observational study with collection of endometrial and endometriotic samples from 53 women with endometriosis and 47 women without endometriosis during surgery. These two groups of patients were treated with levofloxacin (LVFX, 500mg once per os) or GnRHa (1.88 mg/IM for 3 months) before surgery. Endometrial samples were analyzed by broad-range PCR amplification of bacteria targeting V5-V6 region of 16S rRNA gene. Immunohistochemistry was performed using respective target antibodies. 16S rDNA metagenome assay indicated that treatment with either LVFX or GnRHa+LVFX significantly decreased some components of major bacterial genera comparing to untreated group. Occurrence of chronic endometritis was significantly decreased after GnRHa+LVFX treatment. A significantly decreased CD68-stained macrophage infiltration, Ki-67-stained cell proliferation and CD31-stained micro-vessel density was found in endometria and endometriotic lesions with histology-proven improvement in the morphological appearance of endometriosis. These findings suggest that clinical application of a broad-spectrum antibiotic with or without GnRHa may be effective in improving uterine infection in human endometriosis.