【摘要】 目的 研究白细胞分化抗原(CD)38、CD138、多发性骨髓瘤癌基因-1(MUM-1)对慢性子宫内膜炎(CE)的诊断价值，分析体外受精-胚胎移植(IVF-ET)失败的危险因素。方法 回顾性选取2022年1月至2024年1月邯郸市第一医院入院的97例不孕症患者，均行IVF-ET。于手术之前行宫腔镜检查，探查宫腔内部状况并做好记录，择取子宫内膜组织进行活检。选取免疫组织化学染色法测定CD38、CD138、MUM-1水平，诊断金标准为子宫内膜苏木精-伊红染色(HE)法染色结果，分析CE诊断中单一CD38、CD138、MUM-1及联合检测应用价值。97例患者参考生殖预后情况分为成功组(n=44)、失败组(n=53),比较两组研究对象的一般资料，多因素Logistic回归分析IVF-ET失败的危险因素。结果 97例不孕症患者经HE染色显示45例确诊CE。HE染色结果与CD38、CD138、MUM-1免疫组织化学染色结果的Kappa值依次为0.463、0.536、0.474、0.751,一致性较好(P<0.05)。以HE染色结果为诊断金标准，较单一指标检测，CE诊断中联合指标检测的阳性预测值、准确度、灵敏度更高，差异均有统计学意义(P<0.05);较单一CD138、MUM-1,CE诊断中单一CD38灵敏度更高，特异度更低，差异均有统计学意义(P<0.05)。成功组CD38阳性、CD138阳性、MUM-1阳性、CE、人工流产次数≥1次、继发性不孕患者比率分别为36.36%、25.00%、22.73%、31.82%、9.09%、43.18%,均明显低于失败组(60.38%、45.28%、49.06%、58.49%、24.53%、62.26%),差异均有统计学意义(P<0.05);成功组与失败组LH、雌二醇、FSH、基础内膜厚度、月经周期、月经经期、不孕年限、体重指数、年龄比较，差异均无统计学意义(P>0.05)。多因素分析显示，IVF-ET失败危险因素有CD38阳性、CD138阳性、MUM-1阳性、患有CE、人工流产次数≥1次、继发性不孕(P<0.05)。结论 CD38、CD138、MUM-1联合检测可提高CE的诊断准确性，且IVF-ET失败与CD38、CD138及MUM-1阳性和患者患有CE密切相关。更多还原

【Abstract】 Objective To investigate the diagnostic value of leukocyte differentiation antigen(CD) 38, CD138 and multiple myeloma oncogene-1(MUM-1) in chronic endometritis(CE), and analyze the risk factors of failure in vitro fertilization and embryo transfer(IVF-ET). Methods A total of 97 infertility patients admitted to the First Hospital of Handan from January 2022 to January 2024 were retrospectively selected, all of whom underwent IVF-ET. Hysteroscopy was performed before surgery to explore the intrauterine conditions and make records. Endometrial tissue was selected for biopsy, and the levels of CD38, CD138 and MUM-1 were determined by immunohistochemical staining. The gold standard for diagnosis was the results of endometrial hematoxyn-eosin staining(HE). The application value of single CD38, CD138, MUM-1 and combined detection in CE diagnosis was analyzed, and the two groups were divided into the successful group and the failure group based on reproductive prognosis, and the general data of the subjects in the two groups were compared. The risk factors for IVF-ET failure were analyzed by multivariate Logistic regression analysis. Results Among 97 infertile patients, 45 cases were confirmed CE by HE staining. The Kappa values of HE staining results with CD38, CD138 and MUM-1 immunohistochemical staining results were 0.463, 0.536, 0.474 and 0.751, respectively, with good consistency(P<0.05). The results of HE staining were used as the gold standard for diagnosis. Compared with single index detection, the positive predictive value, accuracy and sensitivity of combined index detection in CE diagnosis were higher, and the differences were statistically significant(P<0.05). Compared with single CD138 and MUM-1, single CD38 in CE diagnosis had higher sensitivity and lower specificity, and the differences were statistically significant(P<0.05). The ratios of CD38 positive, CD138 positive, MUM-1 positive, CE, number of induced abortions≥1, and secondary infertility in the successful group were 36.36%, 25.00%, 22.73%, 31.82%, 9.09%, and 43.18%, respectively, which were significantly lower than those in the failure group(60.38%, 45.28%, 49.06%, 58.49%, 24.53%, 62.26%), and the differences were statistically significant(P<0.05). There were no statistically significant differences in basal luteinizing hormone, basal estradiol, basal follicle-stimulating hormone, basal endometrial thickness, menstrual cycle, menstrual period, infertility years, body mass index and age between the successful group and the failure group(P>0.05). Multivariate analysis showed that the risk factors of IVF-ET failure were CD38 positive, CD138 positive, MUM-1 positive, CE, induced abortion≥1 time, secondary infertility(P<0.05). Conclusion The combined detection of CD38, CD138 and MUM-1 can improve the diagnostic accuracy of CE, and the failure of IVF-ET is closely related to the positive CD38, CD138 and MUM-1 and the patients with CE.更多还原