子宫内膜异位症影响妊娠结局的时序性机制
A Temporal Mechanism-Based Framework of Endometriosis Affecting Pregnancy Outcomes
DOI: 10.12677/acm.2026.1641228, PDF,   
作者: 黄雅诗：重庆医科大学第一临床学院，重庆；徐红兵*：重庆医科大学附属第一医院产科，重庆
关键词: 子宫内膜异位症；不良妊娠结局；时序性机制；内膜容受性；胎盘形成；Endometriosis； Adverse Pregnancy Outcome； Temporal Mechanism； Endometrial Receptivity； Placentation
摘要: 子宫内膜异位症(EMs)影响约10%育龄女性，不仅导致不孕，还与不良妊娠结局密切相关。既往研究多将EMs视为静态风险因素，缺乏对妊娠过程动态机制的系统整合。本文基于时序性视角，将EMs对妊娠的影响按孕早期、孕中期、孕晚期分层阐述：孕早期，EMs通过GRB2信号下调、孕激素抵抗和免疫紊乱损害内膜容受性，导致早期流产和反复种植失败；孕中期，蜕膜化缺陷、血管生成失衡和螺旋动脉重铸障碍引发胎盘形成异常，临床表现为前置胎盘、子痫前期和胎盘植入；孕晚期，解剖扭曲、异常宫缩和急性事件(如妊娠期自发性血腹)增加早产、胎儿生长受限及罕见并发症风险。本文构建的时序性机制–临床对应框架，为EMs患者个体化孕期管理提供理论依据，并指出未来研究方向。
Abstract: Endometriosis (EMs) affects approximately 10% of women of reproductive age and is associated with adverse pregnancy outcomes (APO). However, previous studies lack a dynamic perspective on gestational mechanisms. This review proposes a temporal framework across early (implantation), mid (placentation), and late (fetal growth) pregnancy. In early pregnancy, EMs impairs endometrial receptivity via GRB2 downregulation, progesterone resistance, and immune dysfunction, leading to miscarriage and recurrent implantation failure. In mid-pregnancy, defective decidualization, angiogenic imbalance, and impaired spiral artery remodeling cause placental abnormalities, manifesting as placenta previa, preeclampsia, and placenta accreta. In late pregnancy, anatomical distortion, abnormal contractions, and acute events like spontaneous hemoperitoneum (SHiP) increase risks of preterm birth, fetal growth restriction, and rare complications. This framework links stage-specific mechanisms to clinical outcomes, providing a basis for individualized management and future research.
文章引用：黄雅诗, 徐红兵. 子宫内膜异位症影响妊娠结局的时序性机制[J]. 临床医学进展, 2026, 16(4): 85-94. https://doi.org/10.12677/acm.2026.1641228

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