Drizi Amal, Djokovic Dusan, Laganà Antonio Simone, van Herendael Bruno
Independent consultant in Obstetrics and Gynecology, Algiers, Algeria.
Department of Obstetrics and Gynecology, Nova Medical School - Faculdade de Ciências Médicas, Nova University of Lisbon, Lisbon, Portugal.
Prz Menopauzalny. 2020 Jul;19(2):90-100. doi: 10.5114/pm.2020.97863. Epub 2020 Jul 13.
New insights into the complex and fine-regulated inflammatory mechanisms involved in the endometrium reveal multiple facets to the problem of endometrial inflammation. However, the entity termed chronic endometritis is to date restricted to infectious etiology and managed with antibiotics. Conversely, the concept of impaired inflammatory state of the endometrium (IISE) provides a more global approach to defective endometrial inflammation, considering both infectious and non-infectious etiology. A non-systematic review was done through a search on MEDLINE, EMBASE, Global Health, The Cochrane Library, Health Technology Assessment Database and Web of Science, research registers. Pertinent original and review articles, published in English or French until December 31, 2019, were selected. A compelling body of evidence demonstrates transient, repeated and persistent IISE to be a major factor of most problematic disorders in obstetrics/gynecology, such as endometrial polyps, unexplained infertility, miscarriage, placenta-related pathology and endometrial cancer. When scheduled accordingly, hysteroscopy can play a key role in the IISE assessment. Robust data suggests the pertinence of minimal-effective anti-inflammatory regimens for therapeutic IISE targeting. This review provides a comprehensive update on the multiple facets of inflammation in the endometrial physiology and pathology. Further research is needed to improve classification, diagnosis and treatment of IISE.
对子宫内膜中复杂且精细调节的炎症机制的新见解揭示了子宫内膜炎症问题的多个方面。然而，迄今为止，所谓的慢性子宫内膜炎仅限于感染性病因，并采用抗生素治疗。相反，子宫内膜炎症状态受损（IISE）的概念提供了一种更全面的方法来处理有缺陷的子宫内膜炎症，同时考虑感染性和非感染性病因。通过在MEDLINE、EMBASE、全球卫生、考克兰图书馆、卫生技术评估数据库和科学网、研究注册库中进行检索，开展了一项非系统性综述。选取了截至2019年12月31日以英文或法文发表的相关原创文章和综述文章。大量证据表明，短暂性、反复性和持续性IISE是妇产科大多数疑难病症的主要因素，如子宫内膜息肉、不明原因的不孕症、流产、胎盘相关病理学和子宫内膜癌。如果安排得当，宫腔镜检查在IISE评估中可发挥关键作用。有力的数据表明，针对治疗性IISE的最小有效抗炎方案具有相关性。本综述全面更新了子宫内膜生理和病理中炎症的多个方面。需要进一步研究以改进IISE的分类、诊断和治疗。
