阿司匹林联合盆底平滑肌电刺激对宫腔粘连分离术后患者子宫内膜MVD和VEGF表达的影响及其临床意义

Effects of aspirin combined with electrical stimulation of pelvic floor smooth muscle on MVD and VEGF expression in endometrium of patients after hysteroscopic adhesiolysis and its clinical significance

目的:观察宫腔粘连分离术后阿司匹林联合盆底平滑肌电刺激对宫腔粘连(IUA)患者子宫内膜的影响,阐明其对IUA患者术后新生血管形成及血液循环的改善作用。方法:80例中重度IUA并有生育意愿的患者随机分为对照组、药物组、电刺激组和联合组(n=20),均行宫腔镜下宫腔粘连分离术。其中对照组患者行雌孕激素序贯疗法,药物组患者行雌孕激素序贯疗法+阿司匹林治疗,电刺激组患者行雌孕激素序贯疗法联合盆底平滑肌电刺激治疗,联合组患者行雌孕激素序贯疗法+阿司匹林联合盆底平滑肌电刺激治疗。比较各组患者治疗前后疗效,观察各组IUA患者术后子宫内膜厚度(ET)、搏动指数(PI)、阻力指数(RI)、妊娠情况和子宫内膜微血管密度(MVD)值,RT-qPCR法和Western blotting法检测各组IUA患者子宫内膜组织中血管内皮生长因子(VEGF)mRNA和蛋白表达水平。结果:联合组IUA患者总有效率明显高于对照组(P<0.05)。与治疗前比较,治疗后药物组、电刺激组和联合组IUA患者ET明显增加(P<0.05),PI和RI明显降低(P<0.05);治疗后联合组IUA患者PI和RI明显低于对照组、药物组和电刺激组(P<0.05)。与治疗前比较,治疗后电刺激组和联合组IUA患者子宫内膜MVD值明显升高(P<0.05),治疗后联合组IUA患者子宫内膜MVD明显高于对照组、药物组和电刺激组(P<0.05)。与治疗前比较,治疗后对照组、药物组、电刺激组和联合组IUA患者子宫内膜组织中VEGF mRNA和蛋白表达水平明显升高(P<0.05),治疗后联合组IUA患者子宫内膜组织中VEGF mRNA和蛋白水平明显高于对照组、药物组和电刺激组(P<0.05)。结论:宫腔粘连分离术后使用阿司匹林联合盆底平滑肌电刺激可以明显改善患者ET并增加子宫血液循环。

Objective:To observe the effects of aspirin combined with electrical stimulation ofPelvic floor smooth muscle on the endometrium of the intrauterine adhesion(IUA)Patients after hysteroscopic adhesiolysis,and to clarify its improvement effect on the neovascularization and blood circulation after operation of the IUAPatients.Methods:EightyPatients with moderate or severe IUA,having fertility intention,were divided into control group,drug group,electrical stimulation group and combination group(n=20),and all thePatients underwent hysteroscopic adhesidysis.ThePatients in control group were treated with estrogenProgesterone sequential therapy,thePatients in drug group were treated with estrogenProgesterone sequential therapyPlus aspirin,thePatients in electrical stimulation group were treated with estrogenProgesterone sequential therapy combined withPelvic floor smooth muscle stimulation,and thePatients in combination group were treated with estrogenProgesterone sequential therapyPlus aspirin combined withPelvic floor smooth muscle stimulation.The efficacies ofPatients in various groups before and after treatment were compared,and the endometrium thickness(ET),Pulsatility index(PI),resistance index(RI),Pregnancy status,and the endometrium microvessel density(MVD)values of the IUAPatients in various groups were observed;the expression levels of vascular endothelial growth factor(VEGF)mRNA andProtein in endometrial tissue of the IUAPatients in various groups were detected by RT-qPCR and Western blotting methods.Results:The total effective rate ofPatients in combination group was significantly higher than those in control group,drug group and electricalal stimulation group(P<0.05).Compared with before treatment,the ET of the IUAPatients in drug group,electrical stimulation group and combination group after treatment were increased significantly(P<0.05),andPI and RI were decreased significantly(P<0.05);after treatment,thePI and RI of the IUAPatients in combination group were significantly lower than those in control group,drug group and electrical stimulation group(P<0.05).Compared with before treatment,the endometrium MVD values of the IUAPatients in electrical stimulation group and combination group after treatment were increased significantly(P<0.05);the endometrium MVD value of the IUAPatients in combination group was significantly higher than those in control group,drug group and electrical stimulation group(P<0.05).Compared with before treatment,the expression levels of VEGF mRNA andProtein in endometrial tissue of the IUAPatients in control group,drug group,electrical stimulation group and combination group after treatment were significantly increased(P<0.05);after treatment,the expression levels of VEGF mRNA andProtein of the IUAPatients in combination group were significantly higher than those in control group,drug group and electricalal stimulation group(P<0.05).Conclusion:Aspirin combined with electrical stimulationPelvic floor smooth muscle can significantly improve the ET of thePatients,and increase the uterine blood circulation after hysterocopic adhesiolysis.