Hum Reprod Update:生育障碍通过炎症及内分泌影响妊娠结局

2015-09-25 Mechront 译 MedSci原创

生育障碍,很难怀上娃;不孕症,更是难上加难。愁死几家亲。不仅难怀上,并且怀上后问题也更多。没有最痛苦,只有更痛苦。大量的研究表明,有生殖障碍和不孕症的女性其妊娠后相关的产科并发症发生风险更高,并且不良妊娠结局发生率也更高;同时这部分女性想怀孕往往需要借助辅助生殖技术(ART),同时该人群的年龄分布以高龄产妇为主。目前关于有生育障碍和/或不孕症的女性与产科并发症以及不良妊娠结局的研究中,ART、高龄

生育障碍,很难怀上娃;不孕症,更是难上加难。愁死几家亲。不仅难怀上,并且怀上后问题也更多。没有最痛苦,只有更痛苦。

大量的研究表明,有生殖障碍和不孕症的女性其妊娠后相关的产科并发症发生风险更高,并且不良妊娠结局发生率也更高;同时这部分女性想怀孕往往需要借助辅助生殖技术(ART),同时该人群的年龄分布以高龄产妇为主。目前关于有生育障碍和/或不孕症的女性与产科并发症以及不良妊娠结局的研究中,ART、高龄等一些列因素,都是一个个潜在的混杂因素;因此两者间相关性、因果关系的分析都因潜在的混杂因素而充满了挑战。

近期有研究者就该问题检索了PubMed(至2015年6月)上关于有生殖障碍和/或不孕症的女性导致产科并发症以及不良妊娠结局风险增加的潜在机制的研究。

研究者定义的有生殖障碍的女性是指患有子宫内膜异位症、子宫腺肌症、多囊卵巢综合症、以及子宫平滑肌瘤等的女性。通过检索相关文献后研究者发现,不管是如前所述生育障碍还是不明原因的不孕症,在影响妊娠结局导致产科并发症以及不良后果的事件上有着共同的机制。如影响炎症通路、导致激素的变化不协调、致使蜕膜发生衰老变化、以及一系列血管功能的异常等等。


无论是该女性是只具有生殖障碍相关疾病(无论是只有一种还是两种及以上),还是不孕症,其妊娠后以下产科并发症或妊娠不良结局的风险均会增加:早产、胎儿生长受限、病理性胎盘、妊娠高血压疾病等。妊娠后母亲体内激素变化不协调、炎症的产生、以及其他代谢相关因素的改变,均会通过作用于子宫内膜、子宫肌层、子宫颈和胎盘等导致受精卵植入时的环境变得异常,从而从一开始就打下了异常的基础,导致了妊娠期的高风险,产科并发症的风险增高,不良妊娠结局风险增高。不过研究者同时也观察到通过ART技术受孕的女性,其胎盘也可以见到以上这些特征。

研究者通过检索相关文献分析后得出,对于育龄期妇女,以上会导致生殖障碍的相关疾病是很常见的,并且很少单独发生。通常这些疾病会通过影响炎症通路、内分泌和代谢机制造成产科并发症以及不良妊娠结局的发生风险增加。因此临床上对于该类孕妇应该被视为不良妊娠结局的“高风险”人群,并且需要专业化、个性化的监测和随访。同时对于该类孕妇的预防性保健措施、临床管理和产科护理等的发展还需要相关循证医学的支持和实践。

原始出处:

Vannuccini S, Clifton VL, Fraser IS, Taylor HS, Critchley H, Giudice LC, et al. Infertility and reproductive disorders: impact of hormonal and inflammatory mechanisms on pregnancy outcome. Human reproduction update. 2015.

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    2016-01-29 gwc392
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    2015-12-27 忠诚向上

    观点致胜

    0

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    2015-09-27 sunylz

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