Li Yuye, Xu Shiru, Yu Shuyi, Huang Chunyu, Lin Shenglai, Chen Wanru, Mo Meilan, Lian Ruochun, Diao Lianghui, Ding Lijun, Zeng Yong
Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China.
Center for Reproductive Medicine, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, The Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Shandong University, Jinan, China.
Am J Reprod Immunol. 2021 May;85(5):e13369. doi: 10.1111/aji.13369. Epub 2020 Nov 24.
The definition of chronic endometritis (CE) differs among studies, and currently, there is no accepted consensus. This study aimed to establish the minimum number of immunohistochemical analysis of CD138 plasma cells to identify a clinically relevant CE.
We performed a retrospective study on 716 infertile patients who never did CE analysis and respective antibiotic treatment before. Samples were obtained by endometrial scratching in the mid-luteal phase before IVF-ET treatment. The number and distribution of CD138 cells were analyzed by immunohistochemistry. Thirty high-power fields (HPF) were evaluated for each sample. Patients were classified in 2 main groups: (a) CD138 (<5 CD138 cells in all HPFs), (b) CD138 (≥5 CD138 cells in at least one HPF). Pregnancy outcome was compared among the groups.
In the CD138 group, β-hCG positive rate, clinical pregnancy rate and live birth rate were significantly decreased (P = .04, P = .01, P = .04, respectively). Also after adjusting for patient age, body mass index (BMI), and clinical characteristics, the β-hCG positive rate (P = .05), clinical pregnancy rate (P = .01) and live birth rate (P = .02) were significantly lower in the CD138 than those in the CD138 group. Within the CD138 group, these parameters were not significantly different between patients without any plasma cells and patients with up to 4 plasma cells/HPF.
We conclude that immunohistochemical analysis of CD138 cells is a reliable method to detect CE which can be identified by the presence of ≥5 plasma cells in at least one out of 30 HPF.
慢性子宫内膜炎（CE）的定义在不同研究中存在差异，目前尚无公认的共识。本研究旨在确定用于识别具有临床相关性的CE的CD138浆细胞免疫组化分析的最小数量。
我们对716例既往未进行过CE分析及相应抗生素治疗的不孕患者进行了一项回顾性研究。样本在体外受精-胚胎移植（IVF-ET）治疗前的黄体中期通过子宫内膜刮取获得。通过免疫组化分析CD138细胞的数量和分布。每个样本评估30个高倍视野（HPF）。患者分为两个主要组：（a）CD138（所有HPF中CD138细胞<5个），（b）CD138（至少一个HPF中≥5个CD138细胞）。比较两组间的妊娠结局。
在CD138组中，β-hCG阳性率、临床妊娠率和活产率显著降低（分别为P = 0.04、P = 0.01、P = 0.04）。在调整患者年龄、体重指数（BMI）和临床特征后，CD138组的β-hCG阳性率（P = 0.05）、临床妊娠率（P = 0.01）和活产率（P = 0.02）仍显著低于CD138组。在CD138组中，无浆细胞患者和每HPF有多达4个浆细胞的患者之间，这些参数无显著差异。
我们得出结论，CD138细胞的免疫组化分析是检测CE的可靠方法，当在30个HPF中的至少一个中存在≥5个浆细胞时可识别CE。
