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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:

35

期数:

2018年10

页码:

879-883

栏目:

临床研究

出版日期:

2018-10-05

文章信息/Info

Title:

Comparison of different doses of estradiol valerate in the treatment of severe intrauterine adhesions

作者:

郭新颖¹; 郭会敏²; 郭华锋¹

（1.郑州市妇幼保健院妇产科，河南　郑州　450000；2.新乡医学院第一附属医院妇科，河南　卫辉　453100）

Author(s):

GUO Xin-ying¹; GUO Hui-min²; GUO Hua-feng¹

（1.Department of Gynaecology and Obstetrics，Zhengzhou Maternal and Child Health Care Hospital，Zhengzhou 450000，Henan Province，China；2.Department of Gynecology，the First Affiliated Hospital of Xinxiang Medical University，Weihui 453100，Henan Province，China）

关键词:

宫腔粘连; 戊酸雌二醇; 月经; 转化生长因子-β; 基质金属蛋白酶-9; 子宫内膜血流

Keywords:

intrauterine adhesion; estradiol valerate; menstruation; transforming growth factor-β; matrix metalloproteinases-9; endometrial blood flow

分类号:

R711.74

DOI:

10.7683/xxyxyxb.2018.10.008

文献标志码:

A

摘要:

目的　比较不同剂量戊酸雌二醇治疗重度宫腔粘连的临床效果。方法　选择2012年11月至2015年11月郑州市妇幼保健院收治的重度宫腔粘连患者90例为研究对象，所有患者行宫腔镜下宫腔粘连分离术，术后当日开始给予戊酸雌二醇和黄体酮胶囊治疗，根据戊酸雌二醇剂量分为A组（2 mg·d^-1）、B组（4 mg·d^-1）和C组（8 mg·d^-1），每组30例。戊酸雌二醇每个月经周期服用21 d（第2、3周期从月经第5天开始），服用戊酸雌二醇的第12天开始口服黄体酮胶囊100 mg，每日2次，连续10 d；共治疗3个月经周期。分别于治疗前和治疗后第3个月经周期的10～15 d使用阴道三维彩色超声检查子宫内膜厚度、子宫内膜容积及子宫内膜血流情况；分别于治疗前及治疗后第3个月经周期的第10天行宫腔镜检查，应用活检钳留取少量子宫内膜组织，采用免疫组织化学法检测子宫内膜组织中转化生长因子-β（TGF-β）、基质金属蛋白酶-9（MMP-9）表达；记录3组患者治疗前及治疗后第3个月经周期的月经量和月经期；分别于治疗前及治疗后第3个月经周期采用美国生育协会（AFS）评分对患者生育指数进行评估。结果　治疗前3组患者子宫内膜血流、子宫内膜厚度及子宫内膜容积比较差异均无统计学意义（P>0.05）；A组患者治疗后子宫内膜血管搏动指数（PI）显著低于治疗前，血管化指数（VI）、血流指数（FI）及子宫内膜厚度显著高于治疗前（P<0.05）；A组患者治疗前后子宫内膜血流阻力指数（RI）及子宫内膜容积比较差异均无统计学意义（P>0.05）。与治疗前比较，治疗后B组和C组患者子宫内膜RI、PI显著降低，VI、FI、子宫内膜厚度和子宫内膜容积显著升高（P<0.05）。治疗后，B组和C组患者子宫内膜RI、PI显著低于A组，VI、FI、子宫内膜厚度和子宫内膜容积显著高于A组（P<0.05）。B组与C组患者子宫内膜血流参数、子宫内膜厚度及子宫内膜容积比较差异均无统计学意义（P>0.05）。治疗前3组患者月经量、月经期及AFS评分比较差异均无统计学意义（P>0.05）；与治疗前比较，治疗后3组患者月经量增多，月经期延长，AFS评分降低（P<0.05）；治疗后，B组和C组患者月经量显著大于A组（P<0.05），月经期长于A组（P<0.05），AFS评分低于A组（P<0.05）；治疗后B组与C组患者月经量、月经期及AFS评分比较差异均无统计学意义（P>0.05）。治疗前3组患者子宫内膜组织中MMP-9及TGF-β表达比较差异均无统计学意义（P>0.05）；3组患者治疗后子宫内膜组织中MMP-9及TGF-β表达显著低于治疗前（P<0.05）；治疗后，B组和C组患者子宫内膜组织中MMP-9及TGF-β表达显著低于A组（P<0.05），但B组与C组患者子宫内膜组织中MMP-9及TGF-β表达比较差异无统计学意义（P>0.05）。结论　4 mg·d^-1戊酸雌二醇可以有效改善重度宫腔粘连患者的子宫内膜血流，促进子宫内膜恢复，改善预后。

Abstract:

Objective　To compare the clinical effect of different doses of estradiol valerate in the treatment of severe intrauterine adhesions.Methods　Ninety patients with severe intrauterine adhesions in Zhengzhou Maternal and Child Health Hospital from November 2012 to November 2015 were selected as subjects.All patients underwent hysteroscopic separation of intrauterine adhesions and they were treated with estradiol valerate and progesterone capsules on the day after surgery.The patients were divided into group A（2 mg·d^-1），group B（4 mg·d^-1） and group C（8 mg·d^-1） according to the dosage of estradiol valerate，30 cases in each group.Estradiol valerate was administered for twenty-one days per menstrual cycle（from the 5^th day of menstruation in the 2^nd and 3^rd menstrual cycle），and 100 mg progesterone capsules were administered from the 12^th day of using estradiol valerate，twice a day for ten days.All patients were treated for 3 menstrual cycles.The endometrial thickness，endometrial volume and endometrial blood flow were examined by transvaginal three-dimensional color Doppler sonography before treatment and at 10-15 days of the third menstrual cycles after treatment.Hysteroscopy was performed before treatment and on the 10^th day of the third menstrual cycles after treatment，and small amount of endometrial tissues were obtained by biopsy forceps.The expression of transforming growth factor-β（TGF-β） and matrix metalloproteinase-9（MMP-9） in endometrium was detected by immunohistochemistry.The menstrual volume and menstrual period of the patients in the three groups were recorded before treatment and the 3^rd menstrual cycles after treatment.The fertility index was evaluated by American Fertility Society（AFS） score before treatment and in the 3^rd menstrual cycle after treatment.Results　There was no significant difference in endometrial blood flow，endometrial thickness and endometrial volume among the three groups before treatment（P>0.05）.The endometrial vascular pulsation index（PI） after treatment was significantly lower than that before treatment in group A；and vascularization index（VI），flow index（FI） and endometrial thickness after treatment were significantly higher than those before treatment in group A（P<0.05）.There was no significant difference in endometrial blood flow resistance index（RI） and endometrial volume before and after treatment in group A（P>0.05）.Compared with that before treatment，the RI and PI of endometrium were significantly decreased；and the VI，FI，endometrial thickness and endometrial volume were significantly increased after treatment in group B and group C（P<0.05）.The RI and PI of endometrium in group B and group C were significantly lower than those in group A，while the VI，FI，endometrial thickness and endometrial volume were significantly higher than those in group A after treatment（P<0.05）.There was no significant difference in endometrial blood flow parameters，endometrial thickness and endometrial volume between the group B and group C（P>0.05）.There was no significant difference in menstrual volume，menstrual period and AFS score among the three groups before treatment（P>0.05）.Compared with before treatment，the menstrual volume increased，the menstrual period prolonged and AFS score decreased in the three groups after treatment（P<0.05）.Compared with the group A，the menstrual volume was significantly higher，the menstrual period was longer，and the AFS score was lower in the group B and group C after treatment（P<0.05）.There was no significant difference in menstrual volume，menstrual period and AFS score between THE group B and group C after treatment（P>0.05）.There was no significant difference in the expression of MMP-9 and TGF-β in endometrial tissues among the three groups before treatment（P>0.05）.The expression of MMP-9 and TGF-β in endometrial tissues after treatment was significantly lower than that before treatment in the three groups（P<0.05）.The expression of MMP-9 and TGF-β in endometrial tissues in the group B and group C was significantly lower than that in the group A after treatment（P<0.05），but there was no significant difference in the expression of MMP-9 and TGF-β in endometrial tissues between the group B and group C after treatment（P>0.05）.Conclusion　Estradiol valerate 4 mg·d^-1 can effectively improve the endometrial blood flow，promote endometrial recovery，improve the prognosis in patients with severe intrauterine adhesions.

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更新日期/Last Update: 2018-10-05