宫颈机能不全的高危因素及发病机制

doi:10.12280/gjfckx.20230483

摘要/Abstract

摘要：

宫颈机能不全（cervical incompetence，CIC）是一种由于宫颈承托力降低所致的疾病，其可导致复发性流产或早产，增加新生儿不良结局发生率。但目前对于CIC的病因学研究尚不明确，尚无较好的识别与预测方法。先天性或获得性宫颈发育不全、体质量指数、雄激素、抗苗勒管激素和松弛素等内分泌激素以及体外受精-胚胎移植均为CIC的危险因素。导致CIC的原因可能为影响免疫炎症或胶原蛋白合成相关基因突变、内分泌激素对宫颈的重塑作用。目前对于CIC的预测尚无较好的手段，有研究通过超声测量宫颈弹性实现对CIC的预测，也有研究建立CIC的预测模型，但是预测价值均有限。通过对CIC病因学方面的研究进行综述，以期为后续研究提供方向。

关键词: 宫颈功能不全, 环扎术, 宫颈, 危险因素, 发病机制, 预测

Abstract:

Cervical incompetence (CIC) is a disease caused by reduced cervical support, which can lead to recurrent miscarriage or premature birth, increasing the incidence of adverse outcomes in newborns. However, the etiology of CIC is currently unclear and there is no reliable method for identification and prediction. Risk factors for CIC include congenital or acquired cervical hypoplasia, body mass index (BMI), androgens level, anti-Müllerian hormone (AMH), relaxin and other endocrine hormones, as well as in vitro fertilization-embryo transfer (IVF-ET). The cause of CIC may involve gene mutations related to immune inflammation or collagen synthesis, as well as the role of endocrine hormones in cervical remodeling. At present, there is no good method for predicting CIC. There are some studies using ultrasound to measure cervical elasticity to achieve CIC prediction, and there are also studies establishing CIC prediction models, but their predictive value is limited. By reviewing research on the etiology of CIC, we aim to provide direction for future research.

Key words: Uterine cervical incompetence, Cerclage, cervical, Risk factors, Pathogenesis, Forecasting

赵雪晴, 王永清. 宫颈机能不全的高危因素及发病机制[J]. 国际妇产科学杂志, 2024, 51(1): 87-92.

ZHAO Xue-qing, WANG Yong-qing. High Risk Factors and Pathogenesis of Cervical Incompetence[J]. Journal of International Obstetrics and Gynecology, 2024, 51(1): 87-92.

参考文献 33

[1]	Joubert M, Sibiude J, Bounan S, et al. Mid-trimester miscarriage and subsequent pregnancy outcomes: the role of cervical insufficiency in a cohort of 175 cases[J]. J Matern Fetal Neonatal Med, 2022, 35(24):4698-4703. doi: 10.1080/14767058.2020.1861600.
[2]	王永清, 赵扬玉. 宫颈机能不全的病因与诊断的研究进展[J]. 国际妇产科学杂志, 2016, 43(6):630-633. doi: 10.3969/j.issn.1674-1870.2016.06.007.
[3]	Brown R, Gagnon R, Delisle MF. No. 373-Cervical Insufficiency and Cervical Cerclage[J]. J Obstet Gynaecol Can, 2019, 41(2):233-247. doi: 10.1016/j.jogc.2018.08.009. pmid: 30638557
[4]	韩玉, 韩方, 杨海澜. 111例改良McDonald宫颈环扎术患者的临床资料分析[J]. 实用医学杂志, 2019, 35(2):252-256. doi: 10.3969/j.issn.1006-5725.2019.02.019.
[5]	Chen Q, Chen G, Li N. Clinical effect of emergency cervical cerclage and elective cervical cerclage on pregnancy outcome in the cervical-incompetent pregnant women[J]. Arch Gynecol Obstet, 2018, 297(2):401-407. doi: 10.1007/s00404-017-4602-7. pmid: 29222640
[6]	Wu Q, Chen J, Zou Q, et al. An Analysis on the Factors for Cervical Insufficiency Causing Adverse Emotions Among Pregnant Women at Different Gestation Phases[J]. Front Psychiatry, 2022, 13:764345. doi: 10.3389/fpsyt.2022.764345.
[7]	Spiegel E, Nicholls-Dempsey L, Czuzoj-Shulman N, et al. Pregnancy outcomes in women with Ehlers-Danlos Syndrome[J]. J Matern Fetal Neonatal Med, 2022, 35(9):1683-1689. doi: 10.1080/14767058.2020.1767574.
[8]	Panagiotopoulos M, Tseke P, Michala L. Obstetric Complications in Women With Congenital Uterine Anomalies According to the 2013 European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy Classification: A Systematic Review and Meta-analysis[J]. Obstet Gynecol, 2022, 139(1):138-148. doi: 10.1097/AOG.0000000000004627.
[9]	Mastrolia SA, Baumfeld Y, Hershkovitz R, et al. Independent association between uterine malformations and cervical insufficiency: a retrospective population-based cohort study[J]. Arch Gynecol Obstet, 2018, 297(4):919-926. doi: 10.1007/s00404-018-4663-2. pmid: 29392437
[10]	Wu Y, Liang X, Cai M, et al. Development and validation of a model for individualized prediction of cervical insufficiency risks in patients undergoing IVF/ICSI treatment[J]. Reprod Biol Endocrinol, 2021, 19(1):6. doi: 10.1186/s12958-020-00693-x.
[11]	Kyrgiou M, Athanasiou A, Kalliala I, et al. Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease[J]. Cochrane Database Syst Rev, 2017, 11(11):CD012847. doi: 10.1002/14651858.CD012847.
[12]	ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency[J]. Obstet Gynecol, 2014, 123(2 Pt 1):372-379. doi: 10.1097/01.AOG.0000443276.68274.cc. pmid: 24451674
[13]	Gökçe A, Şükür YE, Özmen B, et al. The association between operative hysteroscopy prior to assisted reproductive technology and cervical insufficiency in second trimester[J]. Arch Gynecol Obstet, 2021, 303(5):1347-1352. doi: 10.1007/s00404-020-05863-1. pmid: 33219481
[14]	Venkatesh KK, Cantonwine DE, Zera C, et al. Is There an Association between Body Mass Index and Cervical Length? Implications for Obesity and Cervical Length Management in Pregnancy[J]. Am J Perinatol, 2017, 34(6):568-575. doi: 10.1055/s-0036-1594242. pmid: 27884038
[15]	Abruzzese GA, Silva AF, Velazquez ME, et al. Hyperandrogenism and Polycystic ovary syndrome: Effects in pregnancy and offspring development[J]. WIREs Mech Dis, 2022, 14(5):e1558. doi: 10.1002/wsbm.1558.
[16]	Feigenbaum SL, Crites Y, Hararah MK, et al. Prevalence of cervical insufficiency in polycystic ovarian syndrome[J]. Hum Reprod, 2012, 27(9):2837-2842. doi: 10.1093/humrep/des193.
[17]	Wu Y, Cai M, Liang X, et al. The prevalence of cervical insufficiency in Chinese women with polycystic ovary syndrome undergone ART treatment accompanied with negative prognosis: a retrospective study[J]. J Obstet Gynaecol, 2021, 41(6):888-892. doi: 10.1080/01443615.2020.1819212.
[18]	Wang Y, Gu X, Tao L, et al. Co-morbidity of cervical incompetence with polycystic ovarian syndrome (PCOS) negatively impacts prognosis: A retrospective analysis of 178 patients[J]. BMC Pregnancy Childbirth, 2016, 16(1):308. doi: 10.1186/s12884-016-1094-6.
[19]	Hu KL, Liu FT, Xu H, et al. High antimüllerian hormone levels are associated with preterm delivery in patients with polycystic ovary syndrome[J]. Fertil Steril, 2020, 113(2):444-452.e1. doi: 10.1016/j.fertnstert.2019.09.039.
[20]	康佳. 小鼠Müllerian管发育的分子机制研究[D]. 北京: 中国医学科学院北京协和医学院, 2020.
[21]	顾珣可, 王丁然, 陶立元, 等. 宫颈机能不全孕妇血清松弛素水平的测定[J]. 中华医学杂志, 2015, 95(35):2817-2820. doi: 10.3760/cma.j.issn.0376-2491.2015.35.001.
[22]	Shi Y, Sun Y, Hao C, et al. Transfer of Fresh versus Frozen Embryos in Ovulatory Women[J]. N Engl J Med, 2018, 378(2):126-136. doi: 10.1056/NEJMoa1705334.
[23]	Liu Y, Li R, Wang Y. Clinical outcomes and placental pathological characteristics after fresh embryo transfer and frozen-thawed embryo transfer with different endometrial preparation protocols[J]. Placenta, 2023, 131:65-70. doi: 10.1016/j.placenta.2022.11.011.
[24]	Meng L, Öberg S, Sandström A, et al. Identification of risk factors for incident cervical insufficiency in nulliparous and parous women: a population-based case-control study[J]. BMC Med, 2022, 20(1):348. doi: 10.1186/s12916-022-02542-7. pmid: 36221132
[25]	穆新丹, 郭洁. 生殖道菌群在妊娠中的作用[J]. 国际妇产科学杂志, 2023, 50(4):416-420. doi: 10.12280/gjfckx.20230168.
[26]	Flaviani F, Hezelgrave NL, Kanno T, et al. Cervicovaginal microbiota and metabolome predict preterm birth risk in an ethnically diverse cohort[J]. JCI Insight, 2021, 6(16):e149257. doi: 10.1172/jci.insight.149257.
[27]	Son GH, Choi SY, Ju YJ, et al. Whole blood RNA sequencing reveals a differential transcriptomic profile associated with cervical insufficiency: a pilot study[J]. Reprod Biol Endocrinol, 2021, 19(1):32. doi: 10.1186/s12958-021-00715-2.
[28]	Volozonoka L, Rots D, Kempa I, et al. Genetic landscape of preterm birth due to cervical insufficiency: Comprehensive gene analysis and patient next-generation sequencing data interpretation[J]. PLoS One, 2020, 15(3):e0230771. doi: 10.1371/journal.pone.0230771.
[29]	Kim Y, Lee KY, Lee JJ, et al. Expression of antimicrobial peptides in the amniotic fluid of women with cervical insufficiency[J]. Am J Reprod Immunol, 2022, 88(2):e13577. doi: 10.1111/aji.13577.
[30]	Alves A, Freitas AB, Levi JE, et al. COL1A1, COL4A3, TIMP2 and TGFB1 polymorphisms in cervical insufficiency[J]. J Perinat Med, 2021, 49(5):553-558. doi: 10.1515/jpm-2020-0320.
[31]	Perkhulyn OM, Pakharenko LV, Sukhin VS, et al. Evaluation of hormonal function in women with cervical insufficiency and infertility in the history[J]. Wiad Lek, 2021, 74(10 pt 1):2412-2416. pmid: 34896996
[32]	严欣. 血清松弛素通过调节细胞外基质合成导致宫颈机能不全的机制研究[D]. 北京: 北京大学医学部, 2021.
[33]	Zhang L, Zheng Q, Xie H, et al. Quantitative cervical elastography: a new approach of cervical insufficiency prediction[J]. Arch Gynecol Obstet, 2020, 301(1):207-215. doi: 10.1007/s00404-019-05377-5. pmid: 31758303