Igenomix Academy, Valencia, Spain.
IVI Barcelonaii.
Hum Reprod. 2018 Aug 1;33(8):1374-1380. doi: 10.1093/humrep/dey232.
Asherman's Syndrome (AS) is an acquired condition defined by the presence of intrauterine adhesions (IUA) that cause symptoms such as menstrual abnormalities, pelvic pain, infertility, recurrent miscarriage, abnormal placentation and attendant psychological distress. Classically, AS is considered an iatrogenic disease triggered by trauma to the pregnant uterus. Different factors can cause the destruction of the endometrium, thus affecting the endometrial stem cell niche and creating IUAs. Curettage of the pregnant uterus appears to be the most common source of this destruction. Nevertheless, some AS cases have been associated with congenital uterine abnormalities and infections, and there are some idiopathic cases without any prior surgical procedures, suggesting a putative constitutional predisposition to IUA. Factors reported to cause AS share an underlying inflammatory mechanism leading to defective endometrial healing and vascularization. Interestingly, distinct genetic profiles have been observed in the endometrium of AS patients. These data suggest that AS might not just be an iatrogenic complication, but also the result of a genetic predisposition. Elucidating the possible physiopathological processes that contribute to AS will help to identify patients at risk for this condition, providing an opportunity for prevention.
Asherman 综合征（AS）是一种后天获得性疾病，其特征为宫腔粘连（IUA）引起的月经异常、盆腔痛、不孕、复发性流产、胎盘异常和相关的心理困扰等症状。经典的 AS 被认为是一种医源性疾病，由妊娠子宫创伤引发。多种因素可导致子宫内膜破坏，从而影响子宫内膜干细胞龛，形成 IUA。刮宫术似乎是导致这种破坏的最常见原因。然而，一些 AS 病例与先天性子宫异常和感染有关，还有一些特发性病例没有任何先前的手术，这表明可能存在对 IUA 的先天倾向。据报道，导致 AS 的因素具有潜在的炎症机制，导致子宫内膜愈合和血管生成缺陷。有趣的是，AS 患者的子宫内膜观察到了不同的基因谱。这些数据表明，AS 可能不仅仅是一种医源性并发症，也是遗传易感性的结果。阐明可能导致 AS 的病理生理过程将有助于识别有这种疾病风险的患者，为预防提供机会。
