稽留流产术后人工周期芬吗通治疗效果及其对PAPP-A和HIF-1α影响

Effect of fenmotron in artificial cycles after missed abortion and its influence on PAPP-A and HIF-1α

目的观察稽留流产术后患者使用人工周期芬吗通治疗的效果及其对妊娠相关血浆蛋白-A(PAPP-A)及缺氧诱导因子-1α(HIF-1α)影响。方法选取2016-08-01-2020-12-31内黄县人民医院收治的经超声确诊为稽留流产的80例患者为研究对象,根据随机数字表法分为对照组和观察组,各40例。对照组采用刮宫术+益母草胶囊治疗,观察组采用刮宫术+益母草胶囊+芬吗通治疗。采用t检验或χ^(2)检验对比分析2组患者术后恢复情况(疼痛持续时间、出血量、出血时间)、1周后子宫内膜厚度、月经改善情况(首次复潮时间、首次来潮量)、不良反应、并发症及治疗前后PAPP-A、HIF-1α水平。结果观察组术后疼痛持续时间为(3.15±0.43)d,低于对照组的(4.72±0.56)d,t=14.064,P<0.001;出血量为(80.78±15.63)mL,低于对照组的(96.69±17.51)mL,t=4.287,P<0.001;出血时间为(4.77±1.07)d,低于对照组的(6.12±1.34)d,t=4.979,P<0.001。观察组1周后子宫内膜厚度为(6.55±0.43)mm,高于对照组的(4.16±0.52)mm,t=22.402,P<0.001;首次来潮量为(55.75±8.21)mL,高于对照组的(42.96±10.18)mL,t=6.185,P<0.001;首次复潮时间为(27.03±3.27)d,短于对照组的(36.49±5.36)d,t=9.529,P<0.001。观察组随访3个月的并发症总发生率为7.50%,低于对照组的25.00%,χ^(2)=4.501,P=0.034;2组均未发生严重不良反应,χ^(2)=0.621,P=0.431。治疗后,观察组PAPP-A水平为(10.27±2.06)U/L,低于治疗前的(24.54±3.22)U/L,t=23.610,P<0.001;对照组为(16.91±2.82)U/L,低于治疗前的(24.67±3.15)U/L,t=11.608,P<0.001;且观察组低于对照组,t=12.025,P<0.001。治疗后,观察组HIF-1α水平为(85.64±9.53)ng/L,低于治疗前的(310.24±29.65)ng/L,t=45.611,P<0.001;对照组为(152.17±15.93)ng/L,低于治疗前的(315.14±31.26)ng/L,t=22.667,P<0.001;且观察组低于对照组,t=29.378,P<0.001。结论稽留流产术后通过芬吗通治疗效果显著,不仅可改善PAPP-A、HIF-1α水平,还可有效修复子宫内膜,建立正常月经周期,且安全性高。

Objective To observe the effect of artificial cycle fenmoxton on pregnancy-associated plasma protein-a(PAPP-A)and hypoxia-inducible factor-1α(HIF-1α)in patients after delayed abortion.Methods Totally 80 patients with missed abortion diagnosed by ultrasound in Neihuang County People’s Hospital from August 1,2016 to December 31,2020 were selected as the research objects.According to the random number table method,they were divided into control group and observation group,with 40 cases in each group.The control group was treated with curettage+motherwort capsule,and the observation group was treated with curettage+motherwort capsule+fenmotron.The postoperative recovery(duration of pain,amount of bleeding,bleeding time),endometrial thickness 1 week post-operation,menstrual improvement(time of first menstrual recovery and the amount),adverse reactions,complications,PAPP-A and HIF-1αlevels before and after treatment were compared and analyzed between the two groups using t-test orχ^(2)test.Results The duration of postoperative pain in the observation group was(3.15±0.43)d,shorter than(4.72±0.56)d in the control group,t=14.064,P<0.001.The amount of bleeding was(80.78±15.63)ml,lower than(96.69±17.51)ml in the control group,t=4.287,P<0.001.The bleeding time was(4.77±1.07)d,lower than(6.12±1.34)d in the control group,t=4.979,P<0.001.The thickness of endometrium in the observation group was(6.55±0.43)mm,thicker than(4.16±0.52)mm in the control group,t=22.402,P<0.001.The amount for the first menstruation was(55.75±8.21)ml,more than(42.96±10.18)ml in the control group,t=6.185,P<0.001.The time of first menstruation recovery was(27.03±3.27)d,shorter than that in the control group(36.49±5.36)d,t=9.529,P<0.001.The total incidence of complications in the observation group was 7.50%,lower than 25.00%in the control group,χ~2=4.501,P=0.034.There were no serious adverse reactions in both groups,χ~2=0.621,P=0.431.After treatment,PAPP-A in the observation group was(10.27±2.06)U/L,lower than(24.54±3.22)U/L before treatment,t=23.610,P<0.001.The amount in the control group was(16.91±2.82)U/L,lower than that(24.67±3.15)U/L before treatment,t=11.608,P<0.001,and the amount in the observation group was lower than that in the control group,t=12.025,P<0.001.After treatment,HIF-1αin the observation group was(85.64±9.53)ng/L,lower than the amount(310.24±29.65)ng/L before treatment,t=45.611,P<0.001.The control group was(152.17±15.93)ng/L,lower than(315.14±31.26)ng/L before treatment,t=22.667,P<0.001,and the amount in the observation group was lower than that in the control group,t=29.378,P<0.001.Conclusion Fenmotron treatment after delayed abortion has a significant effect.It can not only improve the levels of PAPP-A and HIF-1α,but also effectively repair the endometrium and establish a normal menstrual cycle,with a high degree of safety.