Yan Xinyang, Jiao Jiao, Wang Xiuxia
Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China.
Shenyang Reproductive Health Clinical Medicine Research Center, Shengjing Hospital of China Medical University, Shenyang, China.
Front Endocrinol (Lausanne). 2025 Jun 12;16:1603570. doi: 10.3389/fendo.2025.1603570. eCollection 2025.
Chronic endometritis (CE) is a subtle but persistent inflammatory disorder of the endometrium that is often underdiagnosed due to its asymptomatic or non-specific presentation. The etiology of CE primarily involves microbial infections and immune dysregulation, often accompanied by microbial dysbiosis. Diagnosis relies on histopathological examination, especially the identification of stromal plasma cells, alongside hysteroscopic findings and microbiological testing, though standardization remains lacking. Mechanistically, CE-induced infertility stems from altered immune cell profiles, impaired endometrial receptivity, aberrant decidualization, dysbiosis of the endometrial microbiota, and abnormal uterine peristalsis. Aberrant gene expression and hormone receptor dysregulation further disrupt the implantation window. This review summarizes current understanding of the diagnostic criteria, pathogenic mechanisms, and therapeutic strategies for CE, emphasizing its crucial role in infertility and the need for standardized clinical management.
慢性子宫内膜炎（CE）是一种隐匿但持续存在的子宫内膜炎症性疾病，因其无症状或表现不具特异性，常被漏诊。CE的病因主要涉及微生物感染和免疫失调，常伴有微生物群落失调。诊断依赖于组织病理学检查，特别是间质浆细胞的识别，同时结合宫腔镜检查结果和微生物检测，不过目前仍缺乏标准化。从机制上讲，CE导致的不孕源于免疫细胞谱改变、子宫内膜容受性受损、蜕膜化异常、子宫内膜微生物群落失调以及子宫蠕动异常。异常的基因表达和激素受体失调进一步扰乱着床窗口。本综述总结了目前对CE的诊断标准、致病机制和治疗策略的认识，强调其在不孕中的关键作用以及标准化临床管理的必要性。
