Santoro Angela, Travaglino Antonio, Inzani Frediano, Angelico Giuseppe, Raffone Antonio, Maruotti Giuseppe Maria, Straccia Patrizia, Arciuolo Damiano, Castri Federica, D'Alessandris Nicoletta, Scaglione Giulia, Valente Michele, Cianfrini Federica, Masciullo Valeria, Zannoni Gian Franco
Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy.
Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS San Matteo Hospital, 27100 Pavia, Italy.
Biomedicines. 2023 Jun 15;11(6):1714. doi: 10.3390/biomedicines11061714.
Chronic endometritis (CE) is the persistent inflammation of the endometrial lining associated with infertility and various forms of reproductive failures. The diagnosis of CE is based on the histological evidence of stromal plasma cells; however, standardized methods to assess plasma cells are still lacking. In the present paper, we aimed to determine the most appropriate plasma cell threshold to diagnose CE based on pregnancy outcomes. Three electronic databases were searched from their inception to February 2022 for all studies comparing pregnancy outcomes between patients with CE and patients without CE. The relative risk (RR) of pregnancy, miscarriage, and/or live birth rates were calculated and pooled based on the plasma cell threshold adopted. A -value < 0.05 was considered significant. Nine studies adopting different thresholds (1 to 50 plasma cells/10 HPF) were included. In the meta-analysis, we only found a significant association between miscarriage rate and a plasma cell count ≥ 5/10 HPF (RR = 2.4; = 0.007). Among studies not suitable for meta-analysis, CE showed an association with worsened pregnancy only when high thresholds (10 and 50/10 HPF) were adopted. In conclusion, our study suggests that the presence of plasma cells at low levels (<5/10 HPF) may not predict worsened pregnancy outcomes. Based on these findings, a threshold of ≥5 plasma cells/10 HPF may be more appropriate to diagnose CE.
慢性子宫内膜炎（CE）是子宫内膜衬里的持续性炎症，与不孕症和各种形式的生殖失败相关。CE的诊断基于基质浆细胞的组织学证据；然而，评估浆细胞的标准化方法仍然缺乏。在本文中，我们旨在根据妊娠结局确定诊断CE的最合适的浆细胞阈值。检索了三个电子数据库，从其建立到2022年2月，查找所有比较CE患者和非CE患者妊娠结局的研究。根据采用的浆细胞阈值计算并汇总妊娠、流产和/或活产率的相对风险（RR）。P值<0.05被认为具有统计学意义。纳入了九项采用不同阈值（1至50个浆细胞/10个高倍视野）的研究。在荟萃分析中，我们仅发现流产率与浆细胞计数≥5/10个高倍视野之间存在显著关联（RR=2.4；P=0.007）。在不适合进行荟萃分析的研究中，仅当采用高阈值（10和50/10个高倍视野）时，CE才显示与妊娠恶化有关。总之，我们的研究表明，低水平（<5/10个高倍视野）的浆细胞存在可能无法预测妊娠结局恶化。基于这些发现，≥5个浆细胞/10个高倍视野的阈值可能更适合诊断CE。
