Chen Xiaoyan, Mariee Najat, Jiang Lingming, Liu Yingyu, Wang Chi Chiu, Li Tin Chiu, Laird Susan
Department of Obstetrics and Gynecology, Chinese University of Hong Kong, Shatin, Hong Kong.
Biomolecular Sciences Research Center, Sheffield Hallam University, Sheffield, United Kingdom.
Am J Obstet Gynecol. 2017 Dec;217(6):680.e1-680.e6. doi: 10.1016/j.ajog.2017.09.010. Epub 2017 Sep 19.
Uterine natural killer cells are the major leukocytes present in the periimplantation endometrium. Previous studies have found controversial differences in uterine natural killer cell percentage in women with recurrent reproductive failure compared with fertile controls.
We sought to compare the uterine natural killer cell percentage in women with recurrent reproductive failure and fertile controls.
This was a retrospective study carried out in university hospitals. A total of 215 women from 3 university centers participated in the study, including 97 women with recurrent miscarriage, 34 women with recurrent implantation failure, and 84 fertile controls. Endometrial biopsy samples were obtained precisely 7 days after luteinization hormone surge in a natural cycle. Endometrial sections were immunostained for CD56 and cell counting was performed by a standardized protocol. Results were expressed as percentage of positive uterine natural killer cell/total stromal cells.
The median uterine natural killer cell percentage in Chinese ovulatory fertile controls in natural cycles was 2.5% (range 0.9-5.3%). Using 5th and 95th percentile to define the lower and upper limits of uterine natural killer cell percentage, the reference range was 1.2-4.5%. Overall, the groups with recurrent reproductive failure had significantly higher uterine natural killer cell percentage than the controls (recurrent miscarriage: median 3.2%, range 0.6-8.8%; recurrent implantation failure: median 3.1%, range 0.8-8.3%). However, there was a subset of both groups (recurrent miscarriage: 16/97; recurrent implantation failure: 6/34) that had lower uterine natural killer cell percentage compared to fertile controls.
A reference range for uterine natural killer cell percentage in fertile women was established. Women with recurrent reproductive failure had uterine natural killer cell percentages both above and below the reference range.
子宫自然杀伤细胞是着床期子宫内膜中存在的主要白细胞。以往研究发现，与生育能力正常的对照组相比，反复生殖失败女性的子宫自然杀伤细胞百分比存在有争议的差异。
我们试图比较反复生殖失败女性与生育能力正常的对照组之间的子宫自然杀伤细胞百分比。
这是一项在大学医院进行的回顾性研究。来自3个大学中心的215名女性参与了该研究，包括97名反复流产的女性、34名反复种植失败的女性和84名生育能力正常的对照组。在自然周期中，于黄体生成素激增后精确7天获取子宫内膜活检样本。子宫内膜切片进行CD56免疫染色，并按照标准化方案进行细胞计数。结果以子宫自然杀伤细胞阳性数/总基质细胞数的百分比表示。
自然周期中中国排卵正常的生育能力正常对照组的子宫自然杀伤细胞百分比中位数为2.5%（范围0.9 - 5.3%）。使用第5和第95百分位数来定义子宫自然杀伤细胞百分比的下限和上限，参考范围为1.2 - 4.5%。总体而言，反复生殖失败组的子宫自然杀伤细胞百分比显著高于对照组（反复流产：中位数3.2%，范围0.6 - 8.8%；反复种植失败：中位数3.1%，范围0.8 - 8.3%）。然而，两组中都有一部分（反复流产组：16/97；反复种植失败组：6/34）子宫自然杀伤细胞百分比低于生育能力正常的对照组。
建立了生育能力正常女性子宫自然杀伤细胞百分比的参考范围。反复生殖失败的女性子宫自然杀伤细胞百分比有的高于参考范围，有的低于参考范围。
