GnRH-a辅助腹腔镜下卵巢囊肿剥离术对患者外周血TNF-α、IL-6、NLRs表达水平的影响

Effect of GnRH-a assisted laparoscopic treatment on the serum TNF-α and IL-6 levels and NLRs mRNA expression in patients with chocolate cyst of ovary

目的:探讨促性腺释放激素激动剂(GnRH-a)辅助腹腔镜下卵巢巧克力囊肿(OEC)剥离术对NOD样受体(NLRs)mRNA相对表达量及血清肿瘤坏死因子(TNF)-α和白介素(IL)-6水平的影响。方法:收集2013年1月至2016年1月陕西省延安市延安大学附属医院妇科收治的OEC患者112例,随机分为对照组和观察组,每组56例。对照组采用腹腔镜下OEC剥离手术治疗,观察组在腹腔镜下OEC剥离手术后加用GnRH-a治疗。术后1年,比较两组临床疗效、复发率、不良反应和妊娠率,检测术前和术后6个月、12个月的激素水平,比较NOD1、NOD2mRNA相对表达量及血清TNF-α、IL-6水平。结果:观察组和对照组的总有效率分别为94.54%、80.00%,复发率分别为3.64%、16.36%,有生育需求的患者的妊娠率分别为52.38%、27.50%,差异均有统计学意义(均P<0.05)。两组术后卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)浓度先下降后升高,术后6个月时观察组上述指标显著低于对照组,术后12个月时显著高于对照组,差异均具有统计学意义(均P<0.05)。术后12个月,两组NOD1、NOD2mRNA相对表达量及血清TNF-α、IL-6水平均显著降低,且观察组显著低于对照组(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论:腹腔镜下OEC剥离术后使用GnRH-a辅助治疗能提高临床有效率、降低复发率,提高妊娠率,降低NOD1、NOD2的表达,下调血清TNF-α和IL-6水平,抑制患者体内炎症状态。

Objective： To investigate the effect of gonadotropin releasing hormone agonist （GnRH-a） assisted laparoscopic treatment on the serum tumor necrosis factor （TNF）-α and interleukin （IL-6） levels and NOD-like receptors （NLRs） mRNA expression in patients with chocolate cyst of ovary.Methods： A total of 112 patients with chocolate cyst of ovary treated in our hospital from January 2013 to January 2016 were selected,and randomly divided into a control group and an observation group,with 56 cases in each group.The patients in the control group received laparoscopic surgery,and those in the observation group were treated as the control group with addition of GnRH-a.After 12 months,the clinical response rate,the incidence of adverse reactions and pregnancy rate were recorded.The serum levels of TNF-α,IL-6,follicle stimulating hormone （FSH）,luteinizing hormone （LH） and estradiol （E2） as well as the NOD1 and NOD2 mRNA expressions at 6 and 12 months post-treatment were detected.Results： The response rate,recurrence rate and pregnancy rate were 94.54% and 80.00%,3.64% and 16.36%,and 52.38% and 27.50% in the observation group and the control group,respectively.There were significant differences between the two groups （ P 〈0.05）.The FSH,LH and E2 levels were decreased at 6 months post-treatment then increased in both groups.After 6 months of treatment,the FSH,LH and E2 levels were lower in the observation group than those in the control group,and were higher after 6 months of treatment （ P 〈0.05）.The NOD1 and NOD2 mRNA expressions and the serum levels of TNF-α and IL-6 of both groups were decreased,and the changes were more obvious in the observation groups （ P 〈0.05）.There was no significant difference in the incidence of adverse reaction between the two groups （ P 〉0.05）.Conclusion： GnRH-a application after laparoscopic surgery could elevate the clinical curative effect and pregnancy rate,reduce the recurrence rate,down-regulate NLRs expression and inhibit inflammatory response in patients with chocolate cyst of ovary.