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目的 了解子宫内膜内异症 (内异症 )患者腹腔液肿瘤坏死因子α(TNF α)和白细胞介素6 (IL 6 )水平的变化及对人精子活动力和鼠胚胎发育的影响。方法 将行诊断性腹腔镜检查的不孕患者 2 5例 ,根据术后诊断分为内异症组 ( 14例 )和对照组 ( 11例 ,盆腔正常 ) ,利用双抗体夹心法检测其腹腔液和腹腔巨噬细胞培养上清液中TNF α和IL 6的水平。并将两组的腹腔液分别与人精子和鼠2细胞期胚胎进行体外培养 ,观察其对人精子活动力和鼠 2细胞期胚胎发育的影响。结果 内异症组腹腔液和腹腔巨噬细胞培养上清液中TNF α[( 0 .33± 0 .15 ) μg/L ,( 7.19± 0 .6 0 ) μg/L]和IL 6[( 0 .49± 0 .6 8) μg/L ,( 1.5 1± 0 .0 8) μg/L]水平 ,较对照组明显升高 (P <0 .0 1)。精子与腹腔液孵育 4h后 ,内异症组精子直线前向运动率和总活动率分别为 5 6 .8%和 6 6 .2 % ,明显低于对照组的 75 .7%和80 .8% (P <0 .0 1)。体外培养 48h后 ,两组小鼠 2细胞期胚胎发育成 16细胞期胚胎的比例分别为32 .5 %和 47.6 % ,差异有极显著性 (P <0 .0 1)。结论 腹腔液细胞因子水平升高可能是导致内异症患者不孕的原因
Objective To investigate the changes of tumor necrosis factor α (TNF α) and interleukin 6 (IL 6) levels in peritoneal fluid of patients with endometriosis (endometriosis) and their effects on human sperm motility and embryonic development. Methods Twenty-five patients with infertility who underwent diagnostic laparoscopy were divided into two groups according to the postoperative diagnosis: endometriosis (14 cases) and control group (11 cases, normal pelvic cavity), and their peritoneal fluid And TNF [alpha] and IL6 levels in peritoneal macrophage culture supernatants. The peritoneal fluid of two groups were respectively cultured in vitro with human spermatozoa and mouse 2-cell stage embryos, and their effects on human sperm motility and 2-cell stage embryonic development were observed. Results TNF α [(0.33 ± 0.15) μg / L, (7.19 ± 0.60) μg / L] and IL 6 [( 0.49 ± 0.68) μg / L, (1.5 1 ± 0.08) μg / L], which was significantly higher than that of the control group (P <0.01). After sperm incubation with peritoneal fluid for 4h, the linear and total activities of sperm in the endometriosis group were 56.8% and 66.2% respectively, which were significantly lower than 75.7% and 80.8% in the control group % (P <0 .0 1). After cultured in vitro for 48h, the percentage of embryos in two-cell stage to 16-cell embryos was 32.5% and 47.6%, respectively, with significant difference (P <0.01). Conclusion The increase of cytokines in peritoneal fluid may be the cause of infertility in patients with endometriosis