Endometrial Physiology

我们最近研究了子宫内膜异位症患者月经周期着床期子宫内膜是否异常。我们采用前瞻性观察性研究设计，评估了植入的生物标志物糖蛋白A(GDA)、骨桥蛋白(OPN)、溶血磷脂酸受体3(LPA3)和HOXA10在患有和不患有子宫内膜异位症的妇女在位内膜中的表达。对24例子宫内膜异位症患者和23例年龄相仿的健康志愿者进行分泌期子宫内膜活检，观察GDA、OPN、LPA3和HOXA10的免疫组织化学染色强度和定位。周期第22天后，患者子宫内膜GDA表达显著减少。子宫内膜异位症患者子宫内膜中OPN在分泌晚期表达减少，LPA3和HOXA10在分泌中期和分泌晚期表达减少。在子宫内膜异位症患者中，这四种生物标记物的表达降低可能表明子宫内膜容受性受损，这为即使在很少植入盆腔的妇女中也观察到不孕不育提供了一种解释。由于这些标记物中的许多是孕激素依赖性的，这些发现表明在这一人群中子宫内膜孕酮作用减弱的可能性。

We recently studied whether the endometrium of women with endometriosis might be abnormal during the implantation phase of the menstrual cycle. We evaluated the expression of biomarkers of implantation, glycodelin A (GdA), osteopontin (OPN), lysophosphatidic acid receptor 3 (LPA3), and HOXA10, in eutopic endometrium of women with and without endometriosis using a prospective observational study design. Twenty-four women with endometriosis and 23 healthy volunteers of similar age underwent an endometrial biopsy in the secretory phase and the immunohistochemical staining intensity and localization of GdA, OPN, LPA3, and HOXA10 was evaluated. Endometrial GdA expression was significantly reduced in patients after cycle day 22. The endometrium from women with endometriosis also showed decreased expression of OPN in the late secretory phase and LPA3 and HOXA10 expression in the midsecretory and late secretory phases. The decreased expression of these four biomarkers of implantation may indicate impaired endometrial receptivity in patients with endometriosis, providing one explanation for the subfertility observed even in women with few pelvic implants. Because many of these markers are progesterone dependent, these findings suggest the possibility of reduced endometrial progesterone action in this population.