Dipartimento di Scienze della Salute della Donna e del Bambino, Area Salute Donna, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italia.
Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italia.
Am J Reprod Immunol. 2018 Dec;80(6):e13065. doi: 10.1111/aji.13065. Epub 2018 Oct 30.
In recent years, extended scientific works shed light on the important role played by the endometrium in early pregnancy. This review examines our current knowledge about the delicate balance between microbial and cellular immune agents at endometrial level: All of them might affect endometrial receptivity. In contrast to the classical thinking of human endometrium as a sterile tissue, several recent studies have drawn attention to a resident population of microorganisms, which reaches only a 30% of concordance with those of the cervical-vaginal flora. At present, the understanding of the microbiome in relation to human reproduction is in its infancy and further studies are needed to clarify the activity of endometrial microbiome and the possible effects of a "reproductive tract dysbiosis" on fertility. Moreover, in the human endometrium, there is a complex system works preventing the risk of infection as well as enabling, when pregnancy occurs, the acceptance of the blastocyst. In this way, the endometrium plays a central role in the uterine immune surveillance. A better understanding of the different agents that may affect endometrial receptivity would improve the diagnosis and treatment of obstetric complications related to defective implantation and placentation.
近年来，大量的科学研究揭示了子宫内膜在早期妊娠中的重要作用。本文综述了我们目前对子宫内膜水平上微生物和细胞免疫因子之间微妙平衡的认识：它们都可能影响子宫内膜容受性。与传统观点认为人类子宫内膜是无菌组织不同，最近的几项研究引起了人们对子宫内膜常驻微生物群的关注，其与宫颈阴道菌群的一致性仅为 30%。目前，对微生物组与人类生殖的关系的理解还处于起步阶段，需要进一步研究来阐明子宫内膜微生物组的活性以及“生殖道失调”对生育能力的可能影响。此外，在人类子宫内膜中，存在着一个复杂的系统，既能防止感染的风险，又能在妊娠发生时允许胚泡着床。这样，子宫内膜在子宫免疫监测中起着核心作用。更好地了解可能影响子宫内膜容受性的不同因素，将有助于改善与植入和胎盘形成缺陷相关的产科并发症的诊断和治疗。
