Department of Gynecology, Ningbo Women and Children's Hospital, #339 Liuting Road, Ningbo, Zhejiang, China.
Department of Basic Research Laboratory, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China.
BMC Womens Health. 2024 Feb 29;24(1):148. doi: 10.1186/s12905-024-02985-5.
Endometriosis (EM) is a multifactorial disease that affects 10 - 15% of women of reproductive age. Additionally, 30-50% of women with EM suffer from infertility. The mechanism of infertility caused by EM has not yet been consistently explained. In recent years, studies have shown a link between infertility associated with EM and changes in the reproductive tract microbiota.
In this study, we involved 26 EM patients (8 cases of stage I-II and 18 cases of stage III-IV) and 31 control subjects who were tubal obstruction-related infertility (TORI). The samples from peritoneal fluid (PF) and uterine fluid (UF) were collected and sequenced by 16 S rRNA amplicon.
In the comparison of microbial diversity, we found no significant differences in the microbial diversity of PF and UF between patients with stage I-II EM and those with TORI. However, there was a significant difference in microbial diversity among patients with stage III-IV EM compared to the previous two groups. Lactobacillus decreased in PF of EM compared to the control group, while it increased in UF. In PF, the abundance of Pseudomonas, Enterococcus, Dubosiella and Klebsiella was significantly higher in patients with stage III-IV compared to TORI patients. And in UF, the main differences existed between stage I-II EM compared to the other two groups. The abundance of pontibacter, aquabacterium, Rikenellaceae and so on at the genus level was significantly enriched in the EM patients with stage I-II. In the analysis based on KEGG database, EM may affect the receptivity related pathways of the endometrium by influencing changes in the uterine microbiota.
Our results indicated that as EM progresses, the microorganisms in UF and PF keep changing. These changes in the microbiota, as well as the resulting alternations in gene functional classification, may play an important role in the infertility associated with EM.
子宫内膜异位症（EM）是一种多因素疾病，影响着 10-15%的育龄妇女。此外，30-50%的 EM 患者患有不孕症。EM 导致不孕的机制尚未得到一致解释。近年来，研究表明 EM 相关不孕与生殖道微生物组的变化有关。
本研究纳入了 26 名 EM 患者（8 例 I-II 期和 18 例 III-IV 期）和 31 名因输卵管阻塞相关不孕（TORI）的对照组。采集腹腔液（PF）和宫腔液（UF）样本，通过 16S rRNA 扩增子进行测序。
在微生物多样性比较中，我们发现 I-II 期 EM 患者和 TORI 患者的 PF 和 UF 微生物多样性无显著差异。然而，III-IV 期 EM 患者的微生物多样性与前两组存在显著差异。与对照组相比，EM 患者的 PF 中乳酸杆菌减少，而 UF 中增加。PF 中，III-IV 期 EM 患者的假单胞菌、肠球菌、杜波西氏菌和克雷伯菌丰度明显高于 TORI 患者。UF 中，I-II 期 EM 患者与其他两组的主要差异存在。 Pontibacter、Aquabacterium、Rikenellaceae 等属在 I-II 期 EM 患者中显著富集。基于 KEGG 数据库的分析表明，EM 可能通过影响子宫微生物群的变化来影响子宫内膜的容受性相关途径。
我们的结果表明，随着 EM 的进展，UF 和 PF 中的微生物不断变化。这些微生物群的变化以及由此导致的基因功能分类的改变，可能在 EM 相关不孕中发挥重要作用。
