黄体中期血清抑制素A浓度作为子宫内膜分化的标志物。

Creus M, Ordi J, Fábregues F, Casamitjana R, Vanrell J A, Balasch J

Institut Clinic of Obstetrics and Gynaecology, Faculty of Medicine, University of Barcelona, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.

Hum Reprod. 2001 Jul;16(7):1347-52. doi: 10.1093/humrep/16.7.1347.

BACKGROUND

Recent studies have indicated that the corpus luteum is a major source of circulating inhibin-A and serum concentrations of inhibin-A may reflect the human luteal function. The present prospective study was undertaken to determine the usefulness of mid-luteal serum concentrations of inhibin-A as markers of endometrial receptivity (as assessed by histological dating and alphavbeta3 integrin expression) and whether they are better predictors of endometrial function than serum progesterone.

METHODS

Consecutive infertile women (experimental group, n = 50) with regular menstrual cycles, and fertile women who were requesting contraception and had regular menstrual patterns and normal secretory endometria (control group, n = 10) were included. In all women basal body temperature, luteal serum concentrations of oestradiol, progesterone, prolactin, and inhibin-A, and endometrial biopsies were used in the same cycle to assess luteal function.

RESULTS

Out-of-phase mid-secretory endometria were detected in 17 of the 50 infertile women. Lack of alphavbeta3 integrin expression was detected in 27 of the 50 mid-luteal endometrial biopsies. Thus, hormonal concentrations were compared in the mid-luteal phase between the following eight groups of women: group 1 (n = 10), control fertile women; group 2 (n = 50), infertile women (all); subdivided into group 3 (n = 33), with in-phase biopsies; group 4 (n = 17), with out-of-phase endometria; group 5 (n = 23), expressing alphavbeta3 integrin in endometria; group 6 (n = 27), whose endometria did not express alphavbeta3 integrin; group 7 (n = 18), with both in-phase endometrial biopsy and alphavbeta3 integrin expression; and finally group 8 (n = 12), whose endometria were out-of-phase and did not express alphavbeta3 integrin. Mid-luteal serum concentrations of oestradiol, progesterone, prolactin, and inhibin-A of the seven infertile groups were similar to those of the control group of fertile women. No statistically significant difference between the infertile groups was observed for any hormonal parameter considered.

CONCLUSION

Mid-luteal serum inhibin-A determination does not accurately reflect endometrial function/maturation and it is not a better indicator of endometrial luteal phase dysfunction than mid-luteal serum progesterone.

背景

近期研究表明，黄体是循环中抑制素-A的主要来源，抑制素-A的血清浓度可能反映人类黄体功能。本前瞻性研究旨在确定黄体中期血清抑制素-A浓度作为子宫内膜容受性标志物的有用性（通过组织学分期和αvβ3整合素表达评估），以及它们是否比血清孕酮更能预测子宫内膜功能。

方法

纳入连续的月经周期规律的不孕妇女（实验组，n = 50），以及要求避孕且月经周期规律、分泌期子宫内膜正常的有生育能力的妇女（对照组，n = 10）。在所有妇女的同一周期中，使用基础体温、黄体期血清雌二醇、孕酮、催乳素和抑制素-A浓度以及子宫内膜活检来评估黄体功能。

结果

50名不孕妇女中有17名检测到分泌中期子宫内膜不同步。50份黄体中期子宫内膜活检中有27份检测到缺乏αvβ3整合素表达。因此，比较了以下八组妇女黄体中期的激素浓度：第1组（n = 10），有生育能力的对照妇女；第2组（n = 50），不孕妇女（全部）；再细分为第3组（n = 33），活检同步；第4组（n = 17），子宫内膜不同步；第5组（n = 23），子宫内膜表达αvβ3整合素；第6组（n = 27），子宫内膜不表达αvβ3整合素；第7组（n = 18），子宫内膜活检同步且表达αvβ3整合素；最后第8组（n = 12），子宫内膜不同步且不表达αvβ3整合素。七个不孕组的黄体中期血清雌二醇、孕酮、催乳素和抑制素-A浓度与有生育能力的对照妇女组相似。在所考虑的任何激素参数方面，不孕组之间均未观察到统计学上的显著差异。