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目的探讨子宫内膜异位症(内异症)性不孕妇女的腹腔液对人精子运动及穿卵率的影响。方法将行诊断性腹腔镜检查的不孕妇女40例分为内异症组20例,根据r-AFS分期:早期(Ⅰ?Ⅱ)12例,晚期(Ⅲ?Ⅳ)8例,对照组20例为其它原因不孕者,酶标双抗体夹心法(ELISA)测定两组患者腹腔液肿瘤坏死因子(TNF-α)的含量;正常人精液按1∶1比例和两组腹腔液共同孵育,测定精子运动参数(平均曲线速度、平均直线速度、平均路径速度、直线前向运动百分率)和去透明带地鼠卵穿透试验的变化。结果内异症组腹腔液TNF-α含量高于其它原因不孕组(P<0.05),且晚期内异症组的TNF-α又明显高于早期患者(P<0.05);内异症组四项精子运动参数指标均低于对照组,与TNF-α含量呈负相关(P<0.05);内异症组穿卵数值明显低于对照组(P<0.05)。结论体外观察内异症不孕患者腹腔液对精子活力及穿卵受精能力有明显抑制作用,内异症患者腹腔液内TNF-α值升高与疾病程度正相关,可能是导致不孕的机理之一。
Objective To investigate the effect of peritoneal fluid on endometriosis (endometriosis) in infertility women and the rate of weaning. Methods According to the r-AFS staging, there were 12 cases of early stage (Ⅰ Ⅱ Ⅱ), 8 cases of advanced stage (Ⅲ Ⅳ Ⅳ), and the other 20 cases of control group Cases of infertility for other reasons, enzyme-linked double antibody sandwich method (ELISA) determination of peritoneal fluid tumor necrosis factor (TNF-α) levels in two groups; normal sperm 1: 1 ratio and two groups of co-incubation of peritoneal fluid, The sperm motility parameters (average curve velocity, average linear velocity, mean path velocity, linear forward movement percentage) and the changes of zona pellucida penetration test were determined. Results The content of TNF-α in peritoneal fluid of endometriosis group was higher than that in other infertility group (P <0.05), and the level of TNF-α in endometriosis group was significantly higher than that in early stage (P <0.05) The parameters of the four sperm motility parameters were lower than that of the control group, but negatively correlated with the content of TNF-α (P <0.05). The number of endometriosis group was significantly lower than that of the control group (P <0.05). Conclusion In vitro observation of peritoneal fluid in patients with endometriosis and infertility significantly inhibited sperm motility and ability to oocyte fertilization. The increased level of TNF-α in peritoneal fluid of patients with endometriosis was positively correlated with the degree of disease, which may be the mechanism leading to infertility one.