Feng Qing, Gao Bingsi, Zhao Xingping, Huang Huan, Yi Shuijing, Zou Lingxiao, Liu Xinyi, Xue Min, Xu Dabao
Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University, Changsha 410013, China.
Ann Transl Med. 2020 Feb;8(4):56. doi: 10.21037/atm.2020.01.134.
Intrauterine adhesion (IUA), also referred to as Asherman syndrome, is a complication with partial or complete adhesion of the uterine cavity due to fibrotic proliferation after endometrial and uterine wall injury of the newly pregnant uterus. Currently, all IUA research models are based on non-pregnant animals which are ill-suited in mimicking its pathogenesis. This study aimed to establish an animal IUA model caused by surgical abortion and curettage in pregnant rats that is more in line with clinical etiology, and to provide a more ideal animal model for further exploration of the pathogenesis and treatment for IUA.
Fifteen, 13-to-15-day pregnant Sprague-Dawley (SD) rats aged 10 weeks were selected. After incising and removing the embryos, we randomly selected one side of the uterine cavity as the study group (n=15) and scraped it with a curette; the contralateral side of the uterine cavity that underwent no special procedures was used for inclusion in the control group (n=15). Five rats were euthanized and dissected on the 3rd, 7th, and 14th day after surgery respectively. The changes in tissue morphology, the number of endometrial glands, the ratio of endometrial fibrotic area, and the expression level of the transforming growth factor beta (TGF-β) in the endometrium were compared between the 2 groups.
The endometrial granular cell number in the study group on the 7th and 14th day postoperatively was 3.87±0.72 & 2.59±0.90 in each visual field (×100) respectively, which was significantly lower than that of the control group (6.48±0.96 & 7.53±1.10; P<0.05). The ratio of the endometrial stromal fibrotic area in the study group was significantly higher than that of the control group post-operatively on the 3rd day (0.0974±0.0430 0.0584±0.05110), 7th day (0.1551±0.0348 0.0328±0.0152), and 14th day (0.1518±0.0477 0.0311±0.0128) (P<0.05). The endometrial TGF-β expression in the study group was positive on the 14th day postoperatively while weakly expressed in the control group, and the integrated optical density (IOD) value (5,608.8±2,887.3) was higher than that of the control group (388.3±98.6) (P<0.05). The endometrial TGF-β expression in the study group and control group was relatively weak on the 3rd and 7th day after surgery, and there was no significant difference when compared with that of the control group (P>0.05).
The establishment of an animal model of IUA after surgical abortion and curettage in pregnant rats was successful and is thus feasible for further studies; the model may be a more effective mimic for the generation of human IUA.
宫腔粘连（IUA），也称为阿谢曼综合征，是一种因早孕子宫的子宫内膜和子宫壁损伤后纤维化增生导致子宫腔部分或完全粘连的并发症。目前，所有IUA研究模型均基于非妊娠动物，这在模拟其发病机制方面并不合适。本研究旨在建立一种由妊娠大鼠手术流产和刮宫引起的动物IUA模型，该模型更符合临床病因，并为进一步探索IUA的发病机制和治疗方法提供更理想的动物模型。
选取15只10周龄、孕13至15天的斯普拉格-道利（SD）大鼠。切开并取出胚胎后，随机选取子宫腔的一侧作为研究组（n = 15），用刮匙刮擦；未进行特殊处理的子宫腔对侧作为对照组（n = 15）。分别在术后第3天、第7天和第14天对5只大鼠实施安乐死并进行解剖。比较两组之间的组织形态变化、子宫内膜腺体数量、子宫内膜纤维化面积比例以及子宫内膜中转化生长因子β（TGF-β）的表达水平。
术后第7天和第14天，研究组每个视野（×100）中的子宫内膜颗粒细胞数分别为3.87±0.72和2.59±0.90，明显低于对照组（6.48±0.96和7.53±1.10；P<0.05）。术后第3天（0.0974±0.0430对0.0584±0.0511）、第7天（0.1551±0.0348对0.0328±0.0152）和第14天（0.1518±0.0477对0.0311±0.0128），研究组子宫内膜间质纤维化面积比例均显著高于对照组（P<0.05）。术后第14天，研究组子宫内膜TGF-β表达呈阳性，而对照组表达较弱，积分光密度（IOD）值（5608.8±2887.3）高于对照组（388.3±98.6）（P<0.05）。术后第3天和第7天，研究组和对照组子宫内膜TGF-β表达均较弱，与对照组相比无显著差异（P>0.05）。
妊娠大鼠手术流产和刮宫后IUA动物模型的建立成功，因此对于进一步研究是可行的；该模型可能是更有效的人类IUA发生模拟模型。
