Lixiang Liu1, Huan Yang1, Yaling Guo2, Guoxia Yang2, Yuqing Chen3. 1. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China. 2. Department of Obstetrics and Gynecology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China. 3. Department of Obstetrics and Gynecology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China. Electronic address: chyqing@mail.sysu.edu.cn.
Abstract
OBJECTIVE: To study the effect of chronic endometritis (CE) diagnosed by CD138 immunohistochemical (IHC) staining on endometrial fibrosis and reproductive prognosis in patients with moderate or severe intrauterine adhesions (IUAs). DESIGN: Prospective cohort study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENT(S): One hundred sixty-seven women with moderate to severe IUAs. INTERVENTION(S): Transcervical resection of adhesions (TCRA) and endometrial biopsy were performed in all patients. According to results of IHC staining with anti-syndecan-1 antibodies to identify CD138 cells, participants were classified into two groups: 78 patients with CE (CE group) and 89 women without CE (NCE group). IHC staining for fibrosis markers transforming growth factor beta 1, anti-fibrosis markers matrix metalloproteinase 9, and endometrial receptivity marker integrin alpha v beta 3 was later applied to all tissue samples. MAIN OUTCOME MEASURE(S): Endometrial fibrosis, endometrial receptivity, and reproductive prognosis. RESULT(S): CE diagnosed by CD138 IHC staining has a high incidence, 46%, in moderate and severe IUAs. In the CE group, the expression of transforming growth factor beta 1 was higher than that in the NCE group, and the expression of matrix metalloproteinase 9 and alpha v beta 3 was lower than that in the NCE group. The pregnancy rate and live birth rate in the NCE group were higher than those in the CE group (42.7% vs. 31.5%, 26.9% vs. 17.9%). CONCLUSION(S): CE may affect the endometrial fibrosis homeostasis in IUAs. Women with CE were more likely to experience recurrence of adhesions and had poorer reproductive outcomes. CLINICAL TRIAL REGISTRATION NO: NCT02744807.
OBJECTIVE: To study the effect of chronic endometritis (CE) diagnosed by CD138 immunohistochemical (IHC) staining on endometrial fibrosis and reproductive prognosis in patients with moderate or severe intrauterine adhesions (IUAs). DESIGN: Prospective cohort study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENT(S): One hundred sixty-seven women with moderate to severe IUAs. INTERVENTION(S): Transcervical resection of adhesions (TCRA) and endometrial biopsy were performed in all patients. According to results of IHC staining with anti-syndecan-1 antibodies to identify CD138 cells, participants were classified into two groups: 78 patients with CE (CE group) and 89 women without CE (NCE group). IHC staining for fibrosis markers transforming growth factor beta 1, anti-fibrosis markers matrix metalloproteinase 9, and endometrial receptivity marker integrin alpha v beta 3 was later applied to all tissue samples. MAIN OUTCOME MEASURE(S): Endometrial fibrosis, endometrial receptivity, and reproductive prognosis. RESULT(S): CE diagnosed by CD138 IHC staining has a high incidence, 46%, in moderate and severe IUAs. In the CE group, the expression of transforming growth factor beta 1 was higher than that in the NCE group, and the expression of matrix metalloproteinase 9 and alpha v beta 3 was lower than that in the NCE group. The pregnancy rate and live birth rate in the NCE group were higher than those in the CE group (42.7% vs. 31.5%, 26.9% vs. 17.9%). CONCLUSION(S): CE may affect the endometrial fibrosis homeostasis in IUAs. Women with CE were more likely to experience recurrence of adhesions and had poorer reproductive outcomes. CLINICAL TRIAL REGISTRATION NO: NCT02744807.