摘要
目的研究不孕症患者宫腔镜检查情况及子宫内膜间质中浆细胞相关免疫标记物[CD38、CD138、多发性骨髓瘤癌基因-1(MUM-1)]表达情况,探讨宫腔镜联合免疫组化检测在不孕症合并慢性子宫内膜炎(CE)患者中的诊断价值。方法选取2022年2月至2024年9月于芜湖市第二人民医院因不孕症行宫腔镜检查及诊断性刮宫的104例患者为研究对象,宫腔镜下观察子宫内膜形态学特征,并行组织病理学苏木精-伊红(HE)染色及免疫组化(CD38、CD138、MUM-1)检测(三联检测),镜下观察浆细胞浸润情况。评估浆细胞相关免疫标记物的两种诊断阈值标准[子宫内膜间质浆细胞(ESPC)<5/10个高倍视野(10 HPF)、ESPC≥5/10 HPF]对CE的诊断价值,分析宫腔镜检查、HE染色、三联检测(ESPC<5/10 HPF标准)及三联检测(ESPC≥5/10 HPF标准)4种不同诊断方法在不孕症合并CE中的诊断效能。结果宫腔镜确诊的60例患者中4种不同诊断方法间宫腔镜下子宫内膜特征无显著性差异(P>0.05)。104例不孕症患者采用不同诊断方法检出CE的情况如下:(1)宫腔镜检查:60例(57.69%);(2)HE染色:38例(36.54%);(3)三联检测(ESPC<5/10 HPF标准):88例(84.62%);(4)三联检测(ESPC≥5/10 HPF标准):66例(63.46%)。4种诊断方法对CE的检出率存在显著性差异(Q=61.355,P<0.01),三联检测(ESPC<5/10 HPF)检出率最高,HE染色检出率最低。免疫组化检测结果显示:不同标记物间诊断率有显著性差异(P<0.05);两种浆细胞计数阈值标准在不同标记物中的差异均具有统计学意义(P<0.01)。宫腔镜检查与三联检测(ESPC≥5/10 HPF标准)的诊断结果分布无显著性差异(χ^(2)=16.000,P=0.418)。结论在不孕症患者的临床诊疗中,采用宫腔镜下子宫内膜形态学评估联合CD38、CD138和MUM-1免疫组化检测(ESPC≥5/10 HPF标准)的多模式诊断策略,可提升对CE的诊断效能,具有较好的临床应用价值。
Objective:To explore the diagnostic value of hysteroscopy combined with immunohistochemical staining of CD38,CD138 and multiple myeloma oncogene-1(MUM-1)for infertile patients complicated with chronic endometritis(CE).Methods:A total of 104 infertile patients treated at the Second People’s Hospital of Wuhu from February 2022 to September 2024 underwent hysteroscopy and diagnostic curettage.Endometrial morphological features were observed by hysteroscopy.Histopathological evaluation was performed using hematoxylin-eosin(HE)staining,and immunohistochemical staining for CD38,CD138 and MUM-1(triple detection)was applied to quantify plasma cell infiltration under light microscopy.The diagnostic performance of two endometrial stromal plasma cell count thresholds[<5/10 HPF and≥5/10 HPF of the endometrial stromal plasmacyte(ESPC)]for CE was evaluated.The diagnostic value of four different diagnostic methods,including hysteroscopy,HE staining,triple detection(ESPC<5/10 HPF standard),and triple detection(ESPC≥5/10 HPF standard),was analyzed in infertile patients with CE.Results:Hysteroscopic endometrial characteristics showed no significant differences among the four diagnostic methods in the 60 patients diagnosed by hysteroscopy(P>0.05).Of 104 infertile patients diagnosed with CE by different methods,60(57.69%)were diagnosed by hysteroscopy,38(36.54%)by HE staining,88(84.62%)by triple detection(ESPC<5/10 HPF standard)and 66(63.46%)by triple detection(ESPC≥5/10 HPF standard).Significant differences in the detection rate of CE were observed across the four methods(Q=61.355,P<0.01),with the triple detection(ESPC<5/10 HPF standard)having the highest detection rate and HE staining the lowest.Immunohistochemical staining results revealed significant diagnostic rate variations among markers(P<0.05),and the differences in two plasma cell counting threshold standards among different markers were statistically significant(P<0.01).There was no significant difference in the distribution of diagnostic results between hysteroscopy and triple detection(ESPC≥5/10 HPF standard)(χ^(2)=16.000,P=0.418).Conclusions:In the clinical management of infertile patients,a multimodal diagnostic strategy of combining hysteroscopic endometrial morphological assessment with immunohistochemical detection of CD38,CD138 and MUM-1(ESPC≥5/10 HPF standard)can enhance the diagnostic efficacy for CE,demonstrating clinical application value.
作者
陈超婵
谢闵
余红
石春艳
CHEN Chao-chan;XIE Min;YU Hong;SHI Chun-yan(Graduate School of Bengbu Medical University,Bengbu 233030;Department of Pathology,Wuhu Hospital Affiliated to East China Normal University,The Second People’s Hospital of Wuhu,Wuhu 241001;Department of Reproductive Medicine,Wuhu Hospital Affiliated to East China Normal University,The Second People’s Hospital of Wuhu,Wuhu 241001)
出处
《生殖医学杂志》
2025年第8期1071-1078,共8页
Journal of Reproductive Medicine
基金
芜湖市应用基础及创新环境研究项目(2023jc34)。
关键词
慢性子宫内膜炎
不孕症
宫腔镜
免疫组化染色
苏木精-伊红染色
Chronic endometritis
Infertility
Hysteroscopy
Immunohistochemical staining
Hematoxylin-eosin staining
