Cicinelli Ettore, Nicolì Pierpaolo, Vimercati Antonella, Cicinelli Rossana, Marinaccio Marco, Matteo Maria, de Ziegler Dominique, Vitagliano Amerigo
Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro," Policlinico of Bari, Bari, BA, Italy.
Department of Obstetrics, Gynecology, and Reproductive Medicine, Hospital Foch, the University of Paris Ouest (UVSQ), Paris, France.
Int J Gynaecol Obstet. 2025 Sep;170(3):1179-1187. doi: 10.1002/ijgo.70115. Epub 2025 Apr 18.
The causal link between chronic endometritis (CE) and nonstructural abnormal uterine bleeding (AUB) has been poorly investigated and requires further clarification. This study aimed to evaluate the prevalence of CE in women with nonstructural AUB and to assess the effect of CE cure on the menstrual blood loss pattern.
This prospective study was conducted between 2022 and 2024 at the Department of Obstetrics and Gynecology, University of Bari, Italy. Women aged 20-45 undergoing hysteroscopy for AUB with confirmation of nonstructural causes were evaluated for CE and considered affected when both hysteroscopic and histologic/immunohistochemical (HIS/IHC) criteria were met. Women with CE were treated with specific culture-guided therapy. Cure ascertainment was confirmed by triple negativity at hysteroscopy-HIS/IHC-culture (Group A). In cases of a positive test, a second course of therapy, up to three courses, was repeated before declaring a persistent condition (Group B). At enrollment and at end-of-treatment evaluation, all participants completed a questionnaire to describe the bleeding characteristics and the Pictorial Blood Assessment Chart (PBAC). Serum hemoglobin and ferritin were also assessed.
Chronic endometritis was diagnosed in 102 of 145 (70.3%) women with nonstructural AUB enrolled in the study. Out of 102 CE patients, 81 (79.4%) patients showed CE resolution after therapy (group A), while in 21 patients (20.6%) CE was persistent (group B). The duration of heavy bleeding before treatment (baseline) was similar in both groups (P = ns). In contrast, at the end of treatment, days of heavy bleeding, days of spotting, and PBAC scores decreased significantly in group A compared with both same-group baseline assessment and group B. Serum hemoglobin and ferritin levels in cured women (A) were significantly higher than in those with persistent CE (B). PBAC scores in group A at 3 and 6 months after the end of treatment showed persistence of cure benefits on AUB. Finally, among patients with CE diagnosis, both univariate and multivariate regressions showed a significant association between cure of CE and reduced bleeding.
Chronic endometritis was highly prevalent in women with nonstructural AUB in our cohort. Cure of CE by targeted antimicrobial therapy led to significant improvements in bleeding patterns.
慢性子宫内膜炎（CE）与非结构性异常子宫出血（AUB）之间的因果关系研究较少，需要进一步阐明。本研究旨在评估非结构性AUB女性中CE的患病率，并评估CE治愈对月经量失血模式的影响。
本前瞻性研究于2022年至2024年在意大利巴里大学妇产科进行。对年龄在20 - 45岁因AUB接受宫腔镜检查且确诊为非结构性病因的女性进行CE评估，当宫腔镜检查和组织学/免疫组织化学（HIS/IHC）标准均满足时判定为患病。患有CE的女性接受特定的培养指导治疗。通过宫腔镜检查 - HIS/IHC - 培养三联阴性确认治愈（A组）。检测结果为阳性的病例，在宣布病情持续之前重复第二个疗程的治疗，最多三个疗程（B组）。在入组时和治疗结束评估时，所有参与者完成一份问卷以描述出血特征和图片式失血评估图（PBAC）。还评估了血清血红蛋白和铁蛋白。
在纳入研究的145例非结构性AUB女性中，102例（70.3%）被诊断为慢性子宫内膜炎。在102例CE患者中，81例（79.4%）患者治疗后CE得到缓解（A组），而21例患者（20.6%）CE持续存在（B组）。两组治疗前（基线）的大量出血持续时间相似（P = 无统计学意义）。相比之下，在治疗结束时，与同组基线评估和B组相比，A组的大量出血天数、点滴出血天数和PBAC评分均显著降低。治愈女性（A组）的血清血红蛋白和铁蛋白水平显著高于CE持续存在的女性（B组）。治疗结束后3个月和6个月时，A组的PBAC评分显示对AUB的治愈益处持续存在。最后，在CE诊断患者中，单因素和多因素回归均显示CE治愈与出血减少之间存在显著关联。
在我们的队列中，慢性子宫内膜炎在非结构性AUB女性中高度流行。针对性抗菌治疗治愈CE可显著改善出血模式。
