背景:子宫内膜异位症(EM)是一种多因素疾病,影响10-15%的育龄妇女。此外,30-50%的女性患有不孕症。由EM引起的不孕症的机制尚未得到一致的解释。近年来,研究表明,与EM相关的不育与生殖道微生物群的变化之间存在联系。
方法:在本研究中,我们纳入了26例EM患者(8例I-II期和18例III-IV期)和31例输卵管阻塞相关性不孕症(TORI)对照受试者.收集来自腹膜液(PF)和子宫液(UF)的样品并通过16SrRNA扩增子测序。
结果:在微生物多样性的比较中,我们发现I-II期EM患者和TORI患者之间PF和UF的微生物多样性没有显著差异.然而,与前两组相比,III-IV期EM患者的微生物多样性存在显著差异.与对照组相比,EM的PF中的乳酸杆菌减少,虽然它在UF中增加。在PF中,大量的假单胞菌,肠球菌,与TORI患者相比,III-IV期患者的Dubosiella和克雷伯菌明显更高。在UF,与其他两组相比,I-II期EM之间存在主要差异。丰富的pontibacter,水杆菌,Rikenellaceae等在属水平上明显富集了I-II期EM患者。在基于KEGG数据库的分析中,EM可能通过影响子宫微生物群的变化来影响子宫内膜的容受性相关途径。
结论:我们的结果表明,随着EM的进展,UF和PF中的微生物不断变化。微生物群的这些变化,以及由此产生的基因功能分类的变化,可能在与EM相关的不孕症中起重要作用。
BACKGROUND: Endometriosis (EM) is a multifactorial disease that affects 10 - 15% of women of reproductive age. Additionally, 30-50% of women with EM suffer from infertility. The mechanism of infertility caused by EM has not yet been consistently explained. In recent years, studies have shown a link between infertility associated with EM and changes in the reproductive tract microbiota.
METHODS: In this study, we involved 26 EM patients (8 cases of stage I-II and 18 cases of stage III-IV) and 31 control subjects who were tubal obstruction-related infertility (TORI). The samples from peritoneal fluid (PF) and uterine fluid (UF) were collected and sequenced by 16 S rRNA amplicon.
RESULTS: In the comparison of microbial diversity, we found no significant differences in the microbial diversity of PF and UF between patients with stage I-II EM and those with TORI. However, there was a significant difference in microbial diversity among patients with stage III-IV EM compared to the previous two groups. Lactobacillus decreased in PF of EM compared to the control group, while it increased in UF. In PF, the abundance of Pseudomonas, Enterococcus, Dubosiella and Klebsiella was significantly higher in patients with stage III-IV compared to TORI patients. And in UF, the main differences existed between stage I-II EM compared to the other two groups. The abundance of pontibacter, aquabacterium, Rikenellaceae and so on at the genus level was significantly enriched in the EM patients with stage I-II. In the analysis based on KEGG database, EM may affect the receptivity related pathways of the endometrium by influencing changes in the uterine microbiota.
CONCLUSIONS: Our results indicated that as EM progresses, the microorganisms in UF and PF keep changing. These changes in the microbiota, as well as the resulting alternations in gene functional classification, may play an important role in the infertility associated with EM.