米非司酮预处理对葡萄胎患者N6-甲基腺嘌呤水平的影响研究

Study on the Effect of Mifepristone Pretreatment on the Level of N6-methyladenine in Hydatidiform Mole

目的:探讨米非司酮预处理对葡萄胎患者N6-甲基腺嘌呤水平的影响。方法:62例需行清宫术的葡萄胎患者,随机分成两组。观察组31例患者清宫术前3d予米非司酮预处理,对照组患者直接行清宫术。患者入院后,留取入院空腹(T0)、清宫后(T1)、术后24h(T2)及术后48h(T3)肘静脉血样,检测N6-甲基腺嘌呤(m6A)、血红蛋白(Hb)、血细胞比容(Hct)、血清β-人绒毛膜促性腺激素(β-HCG)及孕酮(P)水平。观察比较两组手术时间、出血时间及二次清宫率。结果:两组Hb、Hct、出血时间及手术时间无明显差异(P>0.05),但观察组二次清宫率降低明显(P<0.05);β-HCG在观察组内T1、T2及T3检测点较T0检测点下降明显(P<0.05),对照组内T2及T3检测点较T0检测点下降可呈相同的变化,但对照组内T1检测点与T0检测点无明显变化,并且在相同的T1、T2及T3检测点,观察组β-HCG较对照组下降明显(均P<0.05);两组患者P及m6A在组内T1、T2及T3检测点与T0检测点比较,可见与β-HCG相同的变化;同时P及m6A在两组组间比较,可见与β-HCG相同的变化。结论:对葡萄胎给予米非司酮预处理后实施清宫术,能够减少术后出血时间及降低二次清宫率,m6A可作为监测葡萄胎绒毛活性指标,值得临床推广。

Objective:To investigate the effect of mifepristone pretreatment on the level of N6-methyladenine in hydatidiform mole.Methods:62 patients with hydatidiform mole undergoing hydatidiform mole curettage were randomly divided into 2 groups.31 patients in observation group were pretreated with mifepristone three days before curettage,and the other patients received curettage directly.Venous blood samples were collected after fasting in hospital(T0),the end of the operation(T1),at 24 hours after the operation(T2) and 48 hours after the operation(T3)for measurement of hemoglobin(Hb),hematocrit(Hct),β-human chorionic gonadotropin(β-HCG),Progesterone(P)and N6-methyladenine(m6 A).The operation time,bleeding time and the rate of second uterine curettage were observed and compared between the two groups.Results:Compared with the control group,there were no significant differences in Hb,Hct,bleeding volume and operation time in the observation group(P>0.05), but the rate of second uterine curettage decreased significantly(P<0.05).Compared with T0,β-HCG decreased significantly at T1,T2 and T3 in observation group(P<0.05),it also decreased significantly at T2 and T3 in control group(P<0.05), there was no different between T1 and T0 in the control group(P>0.05);then β-HCG decreased significantly in observation group than control group at T1,T2 and T3(P<0.05).While compared the level of P and m6 A at T1,T2 and T3 with those at T0 in the same group,or compared the level of P and m6 A between different group at the same time point, the same changes as β-HCG were observed.Conclusion:Mifepristone pretreatment for hydatidiform mole can reduce the bleeding time and the rate of second uterine clearance, m6 A can be used as an index to monitor the activity of hydatidiform villi,which is worthy of clinical promotion.