Early Pregnancy and Gynaecology Assessment Unit, King's College Hospital, London, UK.
Reprod Biomed Online. 2010 Nov;21(5):610-5. doi: 10.1016/j.rbmo.2010.06.039. Epub 2010 Sep 28.
Uterine fibroids are benign tumours, which are associated with subfertility and early pregnancy loss. This study was carried out to examine the effect of submucous fibroids on concentrations of glycodelin, insulin-like growth factor binding protein-1 (IGFBP-1), interleukin-6 (IL-6), interleukin-10 (IL-10), tumour necrosis factor α (TNFα) and osteopontin in uterine flushings. Premenopausal women with a certain diagnosis of submucous fibroid confirmed on three-dimensional saline infusion sonohysterography were recruited into the study. The control group included women without ultrasonic evidence of any uterine or endometrial pathology. All women had uterine flushings performed 7days post LH surge. Enzyme linked immunoassays were performed to analyse glycodelin, IL-6, IL-10, TNFα and osteopontin, whilst immunoradiometric assay was used to analyse IGFBP-1. In 23 women with submucous fibroids, the concentrations of glycodelin and IL-10 in uterine flushings were significantly lower compared with 17 women in the control group (P=0.002; P=0.007, respectively). There were no significant differences between the two groups in concentrations of IGFBP-1, IL-6, TNFα and osteopontin. Women with submucous fibroids had significantly lower concentrations of glycodelin and IL-10 in mid-luteal phase uterine flushings. This finding may explain the association with submucous fibroids and adverse reproductive outcomes. Uterine fibroids are small growths from the muscle of the uterus (womb). Submucous fibroids protrude into the cavity of the womb. We do not know what causes fibroids to form and grow. In most women, fibroids cause no symptoms and they are sometimes detected on routine gynaecological examination. In some women, however, fibroids can cause heavier and longer menstrual periods. Another problem associated with fibroids is bleeding between periods. The effect of fibroids on fertility is not clear, but some doctors believe that they may also cause infertility and early miscarriage. This study tried to see whether presence of submucous fibroids has any effect on various substances produced by the lining of the womb to facilitate development of early pregnancy. Women with a confirmed diagnosis of submucous fibroids were asked to attend the clinic and have the uterine cavity flushed with a special solution 7days after ovulation. The fluid, which was taken back from the womb, was then analysed to measure the amounts of substances that favour pregnancy development. Women with a normal uterine cavity were also asked to have the uterine cavity flushed to act as a comparison. The study showed that the uterine cavities of women with submucous fibroids were producing decreasing amount of substances favourable to early pregnancy development. We speculate that this may explain why some women with submucous fibroids have difficulties falling pregnant. Our findings should be helpful to doctors advising women with submucous fibroids who wish to start a family.
子宫肌瘤是良性肿瘤，与不孕和早期妊娠丢失有关。本研究旨在研究黏膜下肌瘤对子宫冲洗液中糖蛋白 1（glycodelin）、胰岛素样生长因子结合蛋白-1（IGFBP-1）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNFα）和骨桥蛋白浓度的影响。
经三维盐水灌注超声检查确诊为黏膜下肌瘤的绝经前妇女被纳入研究。对照组包括超声检查无任何子宫或子宫内膜病理的妇女。所有妇女均在 LH 峰后 7 天进行子宫冲洗。采用酶联免疫吸附试验分析糖蛋白 1、IL-6、IL-10、TNFα 和骨桥蛋白，免疫放射分析测定 IGFBP-1。在 23 名患有黏膜下肌瘤的妇女中，子宫冲洗液中的糖蛋白 1 和 IL-10 浓度明显低于对照组的 17 名妇女（P=0.002；P=0.007）。两组 IGFBP-1、IL-6、TNFα 和骨桥蛋白浓度无显著差异。患有黏膜下肌瘤的妇女在黄体中期子宫冲洗液中的糖蛋白 1 和 IL-10 浓度明显较低。这一发现可能解释了黏膜下肌瘤与不良生殖结局之间的关联。
子宫肌瘤是子宫（子宫）肌肉的小生长物。黏膜下肌瘤向子宫腔突出。我们不知道是什么导致了肌瘤的形成和生长。在大多数女性中，肌瘤不会引起症状，有时在常规妇科检查中发现。然而，在一些女性中，肌瘤会导致月经血量增加和经期延长。与肌瘤相关的另一个问题是经期之间出血。肌瘤对生育能力的影响尚不清楚，但一些医生认为它们也可能导致不孕和早期流产。
这项研究试图观察黏膜下肌瘤是否会对促进早期妊娠发展的子宫内层产生的各种物质产生任何影响。经过确诊患有黏膜下肌瘤的妇女被要求到诊所就诊，并在排卵后 7 天接受特殊溶液冲洗子宫。然后分析从子宫中取出的液体以测量有利于妊娠发展的物质的量。也要求正常子宫腔的妇女进行子宫腔冲洗以进行比较。研究表明，患有黏膜下肌瘤的妇女的子宫腔产生的有利于早期妊娠发展的物质数量减少。我们推测，这可能解释了为什么一些患有黏膜下肌瘤的妇女怀孕困难。我们的发现应该有助于为希望生育的患有黏膜下肌瘤的妇女提供建议。
