摘要
目的:探讨子宫内膜异位症(EMs)腹腔镜手术后应用醋酸亮丙瑞林联合坤泰胶囊的疗效及对子宫内膜受容性的影响。方法:将120例接受腹腔镜手术治疗的EMs患者随机分为观察组与对照组各60例。对照组术后采用醋酸亮丙瑞林治疗,观察组采用醋酸亮丙瑞林联合坤泰胶囊治疗。比较两组临床疗效及术后1年内复发率、合并不孕症患者的妊娠情况。治疗前后测定血清血管内皮生长因子(VEGF)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-9(MMP-9)、可溶性细胞间黏附因子-1(sICAM-1)、高迁移率族蛋白1(HMGB1)水平,采用彩色多普勒超声测定子宫内膜厚度及子宫动脉的搏动指数(PI)与阻力指数(RI)。结果:观察组与对照组近期总有效率比较未见差异(96.7%、93.3%,P>0.05),但观察组的1年复发率低于对照组(5.9%、19.2%,P <0.05);治疗后血清VEGF、IL-6、TNF-α、MMP-9、sICAM-1和HMGB1水平低于对照组,子宫内膜厚度高于对照组,子宫动脉PI和RI低于对照组,潮热盗汗、乏力、情绪波动、睡眠障碍、阴道干涩发生率降低(均P<0.05),两组骨痛发生率无明显差异(P>0.05);合并不孕患者随访6、12个月时累计妊娠率,观察组(45.5%、68.2%)高于对照组(16.0%、36.0%)(P<0.05)。结论:EMs腹腔镜手术后应用醋酸亮丙瑞林联合坤泰胶囊能够改善子宫内膜受容性并提高不孕症患者的妊娠率,降低复发率,其机制可能与其抗炎作用及下调VEGF表达有关。
Objective:To investigate the influence of leuprolide acetate combined with Kuntai capsules on endometrial receptivity of patients with endometriosis(EMs)after laparoscopic surgery.Methods:120 patients with EMs who underwent laparoscopic surgery were randomly divided into observation group and control group(60 cases in each group).The patients in control group were treated by leuprolide acetate after surgery,and the patients in observation group were treated by leuprolide acetate combined with Kuntai capsule.The clinical efficacy,the recurrence rate within 1 year,and the pregnancy status of patients with infertility were compared between the two groups.The serum levels of vascular endothelial growth factor(VEGF),interleukin-6(IL-6),tumor necrosis facto-α(TNF-α),matrix metalloproteinase-9(MMP-9),soluble intercellular adhesion molecule-1(sICAM-1),high mobility group box 1(HMGB1)of patients before and after treatment were detected,the endometrial thickness and uterine artery pulsatility index(PI)and resistance index(RI)of patients were measured by color Doppler ultrasound.Results:There was no significant different in the total effective rate between the two groups(96.7% VS.93.3%,P>0.05),but the recurrence rate within 1 year of patients in observation group was significant lower than that of patients in control group(5.9% VS.19.2%,P<0.05).After treatment,the levels of serum VEGF,IL-6,TNF-α,MMP-9,sICAM-1 and HMGB1 of patients in observation group were significant lower than those of patients in control group(P<0.05).After treatment,the endometrial thickness of patients in observation group was significant higher than that of patients in control group,and the uterine artery PI and RI of patients in observation group were significant lower than those of patients in control group(P<0.05).The incidences of hot flashes,night sweats,fatigue,mood swing,sleep disturbance and vaginal dryness of patients in observation group were significant lower than those of patients in control group(P<0.05),but there was no significant different in the incidence of bone pain between the two groups(P>0.05).As for the patients with infertile,the cumulative pregnancy rates of patients at 6 and 12 months after surgery in observation group was45.5%and 68.2%,which were significant higher than those of patients in control group(16.0% and 36.0%,respectively,P<0.05).Conclusion:The application of leuprolide acetate combined with Kuntai capsules used for patients with EMs after laparoscopic surgery can improve the endometrial capacity,can improve the pregnancy rate of infertility patients,and can reduce the recurrence rate.The mechanism may be related to its anti-inflammatory effect and downregulation of VEGF expression.
作者
许宝珍
薛芸
XU Baozhen;XUE Yun(The People's Hospital of Lishui District, Nanjing, Jiangsu Province,211200)
出处
《中国计划生育学杂志》
2018年第12期1183-1188,共6页
Chinese Journal of Family Planning
