自拟中药方对剖宫产术后恶露及子宫内膜MMP-9、TIMP-1的影响

Effect of self-made traditional Chinese medicine prescription on the postoperative lochia after cesarean section and endometrial MMP-9 and TIMP-1

目的探讨自拟中药方对剖宫产术后恶露、子宫内膜基质金属蛋白酶-9(MMP-9)及其特异性组织抑制物-1(TIMP-1)的影响。方法 2016年6月-2017年5月我院行子宫下段剖宫产产妇150例进行研究,随机数字表法分为自拟中药组、益母草组、安慰剂组各50例,自拟中药组采用自拟中药方水煎分2次早晚温服,益母草组口服鲜益母草胶囊2粒/次,3次/d,安慰剂组口服生理盐水100 m L/次,2次/d,3组均于剖宫产术后6 h进行相应治疗,并连续治疗2周。随访并记录血性恶露量、血性恶露持续时间、恶露持续时间;抽取用药前后晨起空腹外周静脉血,全自动生化仪测定白细胞计数(WBC),ELISA法检测血清C反应蛋白(CRP);于手术后及用药后吸取少量蜕膜组织,采用免疫组化检测MMP-9、TIMP-1的表达。结果自拟中药组和益母草组血性恶露量少于安慰剂组,血性恶露持续时间、恶露持续时间短于安慰剂组(P<0.05),而自拟中药组血性恶露量少于益母草组,血性恶露持续时间、恶露持续时间短于益母草组(P<0.05);治疗后自拟中药组和益母草组WBC、CRP低于安慰剂组,而自拟中药组WBC、CRP低于益母草组(P<0.05);治疗后自拟中药组和益母草组MMP-9的表达和MMP-9/TIMP-1比值低于安慰剂组,TIMP-1的表达高于安慰剂组,而自拟中药组MMP-9的表达和MMP-9/TIMP-1比值低于益母草组,TIMP-1的表达高于益母草组(P<0.05)。结论自拟中药方可有效抑制剖宫产术后机体炎症反应,调节MMP-9和TIMP-1的表达,促进子宫复旧,有效减少恶露量及持续时间。

Objective To explore the effect of self-made traditional Chinese medicine prescription on the postoperative lochia after cesarean section and endometrial MMP-9 and TIMP-1. Methods A total of 150 puerpera who were admitted in our hospital from June, 2016 to May, 2017 for lower segment cesarean section were included in the study and randomized into the self-made TCM prescription group, motherwort group, and placebo group with 50 cases in each group. The group of self-made Chinese medicine was prepared with water decoction of self-made traditional Chinese medicine in two times in the morning and evening. The patients in the motherwort group were orally administrated with fresh motherwort capsule, 2 capsules/time, 3 times/d. The patients in the placebo group were orally administrated with normal saline,100 m L/time, 2 times/d. The patients in the three groups were given corresponding treatments 6 h after cesarean section, and continuously treated for 2 weeks. A follow-up visit was paid, and the bloody lochia amount, bloody lochia duration, and lochia duration were recorded. The morning fasting peripheral venous blood before and after treatment was collected. The full aumtomatic biochemical analyzer was used to detect WBC. ELISA was used to detect the serum CRP. A small amount of decidual tissues after operation and medication were absorbed. The immunohistochemistry was used to detect the expressions of MMP-9 and TIMP-1. Results The bloody lochia amount in the self-made TCM prescription group and motherwort group was significantly less than that in the placebo group, and the bloody lochia duration and lochia duration were significantly shorter than those in the placebo group（P〈0.05）. The bloody lochia amount in the self-made TCM prescription group was significantly less than that in the motherwort group, and the bloody lochia duration and lochia duration were significantly shorter than those in the motherwort group（P〈0.05）. WBC and CRP after treatment in the self-made TCM prescription group and motherwort group were significantly lower than those in the placebo group, however, the WBC and CRP of Chinese herbal medicine group was lower than that of motherwort group（P〈0.05）. MMP-9 expression and MMP-9/TIMP-1 after treatment in the self-made TCM prescription group and motherwort group were significantly lower than those in the placebo group, while TIMP-1 expression was significantly higher than that in the placebo group. MMP-9 expression and MMP-9/TIMP-1 after treatment in the self-made TCM prescription group were significantly lower than those in the motherwort group, while TIMP-1 expression was significantly higher than that in the motherwort group（P〈0.05）. Conclusion The self-made TCM prescription can effectively inhibit the inflammatory reaction in patients after cesarean section, regulate MMP-9 and TIMP-1 expressions, promote the uterine involution, and reduce the lochia amount and duration.