| Objectives: To preliminarily explore the effect of HIFUa on endometrial receptivity in the treatment of uterine fibroid and its mechanism through imaging and RAN-Seq.Methods: 1 Thirty patients with uterine fibroid who met the inclusion criteria were enrolled in our study as fibroid group between January 2020 and October 2020.At the same time,30 healthy women of reproductive age were enrolled in our study as non-fibroid group.The pulsatility index(PI),the resistance index(RI),the ratio of the systolic peak value and the end-diastolic velocity of blood flow(S/D)of the uterine arterial blood flow and uterine junctional zone thickness were measured during the implantation window of menstruation in the two groups.We explored the influence of uterine fibroid on endometrial receptivity through comparative analysis.2 All patients underwent HIFUa in fibroid group.Each patient was examined before and after treatment,and at 3 months after treatment by MRI imaging and color doppler ultrasound examination.Reductions of fibroid and uterine volume were assessed.The score of SSS and QOL,the PI,RI,S/D of the uterine arterial blood flow and uterine junctional zone thickness were measured during the implantation window of menstruation before and 3 months after HIFUa.On the basis of clear clinical efficacy,we assessed the effect on endometrial receptivity of HIFUa treatment for fibroids by imaging examination results.3 At the same time,the endometrium of 5 patients before and after HIFUa was collected.And RNA-Seq was used to measure the identify differentially expressed genes in the endometrial tissues before and after HIFUa in order to explore the effect of HIFUa on endometrium receptivity from the expression of gene.Results: 1 There was no significant difference in baseline characteristics such as age,the number of pregnancies and births between two groups.Between the fibroid group and the non-fibroid group,the comparison of the PI on the left side was:1.62±0.61vs2.01±0.48,the comparison of the RI on the left side was 0.73±0.10vs0.81±0.07,the comparison of the S/D on the left side was 4.35±1.87vs6.07±2.14,the comparison of the PI on the right side was 1.64±0.49vs1.92±0.53,the comparison of the RI on the right side was 0.73±0.14vs0.79±0.08,the comparison of the S/D on the right side was 4.73±3.18vs5.7±2.47,the comparison of AJZ was6.38±1.84 vs 5.19±1.40,the comparison of MJZ was 8.64 ±3.18vs6.80±2.17.All above differences were statistically significant(P<0.05).2 All patients underwent HIFUa treatment in the fibroid group and the success rate of treatment was 100%.In these 30 patients,the ablation rate was 75.60±20.59%.Three months later,the rate of uterine volume reduction was 34.86% and the rate of fibroid volume reduction was49.81%.The SSS score of the patients before and after HIFUa treatment was 23.83±5.11vs15.17±5.57,and the QOL score was66.77±19.1vs54.23±16.17,the differences were statistically significant(P<0.05).After HIFUa treatment,the left PI value of fibroid group was1.94±0.56,left RI was0.79±0.07,the left S/D was: 5.4±1.94,the right PI was 1.96±0.47,the right RI was 0.80±0.07,the right S/D was 5.24±1.94,the AJZ was5.43±1.66,the MJZ was 7.20±2.22.Except for the S/D value of the right side,there were statistically significant differences compared with preoperative(P<0.05).Three months after HIFUa treatment,there were no significant differences in PI,RI,S/D,AJZ and MJZ between the fibroid group and the non-fibroid group(P>0.05).3 RNA-Seq was used to explore and discover the differentially expressed genes in endometrium before and after HIFUa treatment.We found that a total of 704 differentially expressed genes were found in endometrium tissue after the operation,among which 214 genes were up-regulated and 409 genes were down-regulated compared with those before HIFUa.Among them,the changes of endometrial receptivity after HIFUa may be related to the down-regulation of LTF,C15orf48,CCL3L1,CCL20,IGLV3-19,BPIFB1,CCL4L2,TNIP3,SLC5A83.And after enrichment analysis,we found that endometrial receptivity transformation after HIFUa may be related to the inflammatory response of reproductive system,immune regulation,IL-17 signaling pathway,cytokine-cytokine receptor interaction.Conclusions: This study demonstrated that intramural fibroids without uterine cavity involvement can affect the endometrial receptivity of patients,while HIFUa treatment can improve endometrial receptivity in patients with uterine fibroid.We have observed the changes of endometrium evaluation indexes such as PI,RI,S/D and JZ thickness through imaging examination results.Besides,HIFUa treatment may can also improve endometrial receptivity of patients through inflammatory and immune responses related to differentially expressed genes.Therefore,HIFUa is a promising treatment option for infertile women with fibroids. |
PDF Full Text Request