重楼生化汤对剖宫产术后子宫内膜MMP-9及其抑制物TIMP-1表达及血白细胞、C-反应蛋白的影响

Effect of Chonglou Shenghua Tang on the expression of MMP-9 and TIMP-1 in endometrium and blood leukocyte and C-reactive protein level after caesarian section

目的:观察重楼生化汤对剖宫产术后子宫内膜基质金属蛋白酶-9(MMP-9)及其基质金属蛋白酶抑制物-1(TIMP-1)表达的影响,以及血白细胞计数、中性粒细胞百分比、血清C-反应蛋白(CRP)的变化,探讨其预防剖宫产术后恶露不绝的机理。方法:选择符合纳入标准及排除标准剖宫产术后产妇60例,随机分成三组,其中实验组(重楼生化汤组)20例,于术后6h起予重楼生化汤100mL,2次/d,连服14d;对照1组(经典生化汤组)20例,术后6 h起予经典生化汤100mL,2次/d,连服14d;安慰剂组20例,术后6h起予安慰剂100mL,2次/d,连服14d。术后第16天应用免疫组织化学法检测各组子宫内膜组织MMP-9及其抑制物TIMP-1的表达,术后第5天、第16天检测血液白细胞计数、中性粒细胞百分比、CRP的变化。结果:重楼生化汤组、经典生化汤组、安慰剂组子宫内膜组织中MMP-9表达依次上升,各组间比较有统计学差异(P均<0.05)。三组TIMP-1表达从高到低依次为:重楼生化汤组、经典生化汤组、安慰剂组。重楼生化汤组显著高于经典生化汤组和安慰剂组(P均<0.05),经典生化汤组与安慰剂组比较无统计学差异(P>0.05)。重楼生化汤组、经典生化汤组、安慰剂组MMP-9/TIMP-1比值依次升高,各组间比较有统计学差异(P均<0.05)。重楼生化汤组、经典生化汤组、安慰剂组术后第5天血白细胞计数、中性粒细胞百分比、CRP,术后第16天血中性粒细胞百分比、CRP依次升高,各组间比较有统计学差异(P均<0.05),术后第16天血白细胞计数各组间比较无统计学差异(P>0.05)。结论:重楼生化汤降低剖宫产术后产妇子宫内膜组织MMP-9的表达,升高TIMP-1的表达,使MMP-9/TIMP-1降低,降低血液中炎性指标与其预防剖宫产术后恶露不绝有关。

AIM： To detect the expression of matrix metalloproteinases-9 （MMP-9） and tissue inhibitor of metalloproteinase-1 （TIMP-1） in endometrium after caesarian section, and the change of blood leukocyte count, neutrophil percentage, serum C-reactive protein （CRP） level, and to explore the mechanism of Chonglou Shenghua Tang for preventing lochiorrhagia after caesarian section （CS）. METHODS： The prospective study was designed as randomized and single blind research from Jan 2011 to Jan 2013. 60 women underwent caesarian section （CS） indicated by obstetric factors were enrolled from the 2ED clinical medical college of Zhejiang Chinese Medical University and assigned into three groups： group of Chonglou Shenghua Tang： 20cases were administered by Chonglou Shenghua Tang 100 mL, per 12 h 14 d after CS; group of Classical Shenghua Tang： 20 cases were admin istered by Classical Shenghua Tang 100 mL, per 12 h 14 d after CS and group of placebo; 20 cases were administered by placebo 100 mL, per 12 h 14 d after CS. The expressions of MMP-9 and TIMP-1 in endometrium were determined using immunohistochemistry at 16th days after CS, and blood leukocyte and CRP were detected at 5th days and 16th days after CS. RESULTS. The levels of MMP-9 expression decreased gradually in Chonglou Shenghua Tang group, Classical Shenghua Tang group and placebo group at 16th days after CS, respectively, with statistical significance （P〈0.05）. The levels of TIMP-9 expression and the ratio of MMP-9/TIMP-1 increased gradually in Chonglou Shenghua Tang group, Classical Shenghua Tang group and placebo group at 16th days after CS, respectively, with statistical significance （P 〈 0.05）. Blood leukocyte count, neutrophil percentage and CRP increased gradually in Chonglou Shenghua Tang group, Classical Shenghua Tang group and placebo group at 5th days and 16th days after CS, respectively, with statistical significance （P〈 0.05）. CONCLUSION： These results suggest that reduced expressions of MMP-9, and increased TIMP-1, and reduced the ratio MMP-9/ TIMP-1 in endometrium and reduced inflammatory indexes in the blood may play important roles in Chonglou Shenghua Tang preventing lochia after cesarean section.