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目的探讨对反复移植失败(RIF)患者进行内膜搔刮后,比较溶血磷脂酸受体3(LPAR3)和同源框基因11(HOXA11)在搔刮组与对照组子宫内膜着床窗口期蛋白的表达差异及临床结局。方法前瞻性纳入61例因输卵管因素不孕行IVF-ET助孕治疗的RIF患者作为研究对象,搔刮组31例患者于冻胚复苏移植的前1个月经周期月经来潮6 h内进行内膜搔刮,对照组30例患者在冻胚复苏移植前未行内膜搔刮。采用免疫组化和Western Blot的实验方法 ,检测LPAR3和HOXA11在以上两组RIF患者排卵后5~7天子宫内膜窗口期蛋白表达量的差异和临床结局。结果两组患者在年龄、不孕年限、体重指数(BMI)、促性腺激素(Gn)天数、Gn总量、获卵数、胚胎移植数、移植日内膜厚度、基础血清卵泡刺激素(FSH)、黄体生成素(LH)及孕酮(P)及着床窗口期血清雌二醇(E2)、P水平相比较,差异无统计学意义(P>0.05),搔刮组生化妊娠率、胚胎着床率、临床妊娠率及持续妊娠率均高于对照组,有统计学差异(P<0.05)。免疫组化结果显示搔刮组腺上皮LPAR3及间质HOXA11在子宫内膜着床窗口期的表达量明显高于对照组,而搔刮组腺上皮HOXA11在子宫内膜着床窗口期的表达量明显低于对照组,差异有统计学意义(P<0.001)。Western Blot结果显示搔刮组LPAR3和HOXA11蛋白在着床窗口期的表达量明显高于对照组,有统计学差异(P<0.001)。结论子宫内膜搔刮术可以提高LPAR3和HOXA11的表达量,从而改善子宫内膜容受性,提高RIF患者的临床妊娠率。
Objective To investigate the effects of lysophosphatidic acid receptor 3 (LPAR3) and homeobox gene 11 (HOXA11) on the endometrial scarring in patients with repeated-graft failure (RIF) Protein expression differences and clinical outcomes. Methods 61 cases of RIF patients treated with IVF-ET assisted by infertility due to fallopian tube were prospectively enrolled. Totally 31 patients in scratch group received intima within 6 hours before menses of menstrual cycle in the first month after transplantation of frozen embryos Scratch, the control group of 30 patients without endometrial scraping before frozen embryo resuscitation. Immunohistochemistry and Western Blot experimental methods to detect LPAR3 and HOXA11 in the above two groups RIF 5 to 7 days after ovulation endometrial window protein expression differences and clinical outcomes. Results The age, duration of infertility, body mass index (BMI), gonadotrophin (Gn) days, total amount of Gn, number of oocytes retrieved, number of embryos transplanted, thickness of endometrium on day of transplantation, basal serum follicle stimulating hormone (P> 0.05). There was no significant difference in the levels of serum progesterone (LH), progesterone (P) and serum estradiol (E2) Embryo implantation rate, clinical pregnancy rate and continuous pregnancy rate were higher than the control group, with statistical significance (P <0.05). The results of immunohistochemistry showed that the expression of LPAR3 and interstitial HOXA11 in the scratch-treated group was significantly higher than that in the control group at the window of endometrium implantation, while the expression of HOXA11 in the scratch-group glandular epithelium at the window of endometrial implantation Significantly lower than the control group, the difference was statistically significant (P <0.001). Western Blot results showed that the expression level of LPAR3 and HOXA11 protein in the scratch group was significantly higher than that in the control group at the implantation window (P <0.001). Conclusion Endometrial scraping can improve the expression of LPAR3 and HOXA11, improve the endometrial receptivity and improve the clinical pregnancy rate of patients with RIF.