不同类型药物对子宫内膜息肉切除术后患者血清性激素、宫腔灌洗液炎症因子及复发的影响

Effects of different types of drugs on serum sex hormones,inflammatory factors in intrauterine lavage fluid,and recurrence of patients after endometrial polypectomy

目的观察不同类型药物对子宫内膜息肉切除术后患者血清性激素、宫腔灌洗液炎症因子及复发的影响,为此类患者术后用药的选择提供参考。方法选取2014年11月-2015年11月该院收治的拟行子宫内膜息肉切除术的患者140例,按照术后使用药物不同分为A组48例,B组和C组各46例,其中A组给予促性腺激素释放激素激动剂(GnRH-a)治疗,B组给予去氧孕烯炔雌醇片治疗,C组给予孕三烯酮治疗。观察3组血红蛋白水平、子宫内膜厚度,检测卵泡刺激素(FSH)、黄体生成素(LH)、孕酮(P)、雌二醇(E_2)水平和白细胞介素-6(IL-6)、干扰素-γ(IFN-γ)水平,统计复发率和不良反应发生率情况。结果术后6个月3组血红蛋白水平显著高于术前(P<0.05),且A组显著高于B组和C组(P<0.05);3组子宫内膜厚度显著低于术前(P<0.05),且A组显著高于B组和C组(P<0.05),术后6个月B组和C组血红蛋白水平、子宫内膜厚度比较,差异无统计学意义(P>0.05);术后6个月3组FSH、LH、P、E_2水平显著低于术前(P<0.05),且A组显著低于B组和C组(P<0.05),B组与C组FSH、LH、P、E_2水平比较,差异无统计学意义(P>0.05);术后6个月3组IL-6水平显著高于术前(P<0.05),且A组显著高于B组和C组(P<0.05);3组IFN-γ水平显著低于术前(P<0.05),且A组显著低于B组和C组(P<0.05);术后6个月B组与C组IL-6、IFN-γ水平比较,差异无统计学意义(P>0.05);A组术后1年复发率显著低于B组和C组(P<0.05);A组不良反应发生率显著低于B组和C组(P<0.05)。结论 GnRH-a、去氧孕烯炔雌醇片、孕三烯酮均可用于治疗子宫内膜息肉切除术后患者,能够降低血清性激素水平,但GnRH-a复发率较低,能够显著改善宫腔灌洗液炎症因子水平,不良反应少。

Objective To observe the effects of different types of drugs on serum sex hormones,inflammatory factors in intrauterine lavage fluid,and recurrence of patients after endometrial polypectomy,provide reference for choice of postoperative drug use among these patients. Methods A total of 140 patients undergoing endometrial polypectomy in Xiaolan People＇s Hospital from November 2014 to November 2015 were selected and divided into group A（ 48 patients）,group B（ 46 patients）,and group C（ 46 patients） according to postoperative drug use. The patients in group A were treated by gonadotropin-releasing hormone angonist（ GnRH-a）,the patients in group B were treated by desogestrel and ethinylestradiol tablets,and the patients in group C were treated by gestrinone. The levels of hemoglobin and endometrial thicknesses in the three groups were observed. The levels of serum follicle-stimulating hormone（ FSH）,luteinizing hormone（ LH）,progesterone（ P）,estradiol（ E2）,interleukin-6（ IL-6）,and interferon-γ（ IFN-γ） in the three groups were detected. The recurrence rates and incidence rates of adverse reactions in the three groups were analyzed statistically. Results The levels of hemoglobin at six months after operation in the three groups were statistically significantly higher than those before operation（ P〈0. 05）. The level of hemoglobin at six months after operation in group A was statistically significantly higher than those in group B and group C（ P〈0. 05）. Endometrial thicknesses after operation in the three groups were statistically significantly lower than those before operation（ P〈0. 05）. Endometrial thickness after operation in group A was statistically significantly higher than those in group B and group C（ P〈0. 05）. At six months after operation,there was no statistically significant difference in the level of hemoglobin and endometrial thickness between group B and group C（ P〈0. 05）. At six months after operation,the levels of FSH,LH,P,and E2 in the three groups were statistically significantly lower than those before operation（ P〈0. 05）. The levels of FSH,LH,P,and E2 at six months after operation in group A were statistically significantly lower than those in group B and group C（ P〈0. 05）. There was no statistically significant difference in the levels of FSH,LH,P,and E_2 between group B and group C（ P〈0. 05）. At six months after operation,the levels of IL-6 in the three groups were statistically significantly higher than those before operation（ P〈0. 05）. The level of IL-6 at six months after operation in group A was statistically significantly higher than those in group B and group C（ P〈0. 05）. The levels of IFN-γ after operation in the three groups were statistically significantly lower than those before operation（ P〈0. 05）. The level of IFN-γ after operation in group A was statistically significantly lower than those in group B and group C（ P〈0. 05）. At six months after operation,there was no statistically significant difference in the levels of IL-6 and IFN-γ between group B and group C（ P〈0. 05）. The recurrence rate at one year after operation in group A was statistically significantly lower than those in group B and group C（ P〈0. 05）. The incidence rate of adverse reactions in group A was statistically significantly lower than those in group B and group C（ P〈0. 05）. Conclusion GnRH-a,desogestrel and ethinylestradiol tablet,and gestrinone can reduce the levels of serum sex hormones in treatment of patients after endometrial polypectomy,but the recurrence rate of GnRH-a is low,and it can significantly improve the levels of inflammatory factors in intrauterine lavage fluid with less adverse reactions.