清宫术后小剂量戊酸雌二醇治疗稽留流产的临床研究

Clinical Study of Low Dose Estradiol Valerate in the Treatment of Missed Abortion After Uterine Curettage

目的探讨清宫术后应用小剂量戊酸雌二醇(E2V)治疗稽留流产(MA)及对雌激素、炎性因子、妊娠相关蛋白A的影响。方法选取2015年1月至2018年12月绵阳市人民医院收治的MA患者98例为研究对象,按照随机数字表法分为小剂量组(n=49)与常规剂量组(n=49),清宫术后小剂量组给予小剂量E2V,常规剂量组给予常规剂量E2V,观察两组术后出血量、出血时间及首次月经中期子宫内膜最大厚度等术后恢复指标、术后宫腔粘连(IUA)情况;分析治疗前后血清β-绒毛膜促性腺激素(β-hCG)、孕酮、雌二醇(E2)等雌激素水平,超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)等炎性因子水平,妊娠相关蛋白A(PAPP-A)及不良反应发生情况。结果两组术后出血量、出血时间及首次月经中期子宫内膜最大厚度比较,差异无统计学意义(P>0.05);治疗后,两组IUA发生情况比较,差异无统计学意义(P>0.05);治疗后,两组β-hCG、P、E2、hs-CRP、TNF-α、IL-6及PAPP-A比较,差异均无统计学意义(P>0.05);小剂量组不良反应发生率(0.00%)低于常规剂量组(8.16%)(P<0.05)。结论清宫术后应用两种剂量E2V均可提高雌孕激素水平,促进残留妊娠组织排出,促进子宫内膜修复,缓解炎性反应,降低PAPP-A水平,但小剂量E2V不良反应少,安全性更高。

Objective To study the effect of low-dose estradiol valerate(E2V)on the treatment of missed abortion(MA)and the levels of estrogen,inflammatory factors and pregnancy associated plasma protein-A(PAPP-A)after uterine curettage.Methods A total of 98 cases with MA admitted to Mianyang People's Hospital from January of 2015 to December of 2018 were selected as the research objects and divided into the low-dose group and the conventional-dose group with 49 cases in each group according to the random number table.The low-dose group was given small dose of E2V and the conventional-dose group was given the conventional dose of E2V after uterine curettage.The recovery indexes including bleeding volume,bleeding time and the maximum thickness of endometrium in the middle of the first menstruation and the status of intrauterine adhesions(IUA)after surgery were observed in the two groups.The levels of PAPP-A,the estrogens including serumβ-human chorionic gonadotrophin(β-hCG),progesterone(P)and estradiol(E2),and the inflammatory factors including serum high-sensitive C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)before and after treatment,and the incidence of adverse reactions were analyzed in the two groups.Results There were no significant differences in postoperative bleeding volume,bleeding time and the maximum thickness of endometrium in the middle of the first menstruation between the two groups(P>0.05).The incidences of IUA were not significantly different between the two groups after treatment(P>0.05).There were no significant differences in the levels ofβ-hCG,P,E2,hs-CRP,TNF-α,IL-6 and PAPP-A between the two groups after treatment(P>0.05).The adverse reaction incidence of the low-dose group(0.00%)was significantly lower than that of the conventional-dose group(8.16%)(P<0.05).Conclusion Low-dose and conventional-dose E2V can improve the level of estrogen and progesterone,promote the expulsion of residual pregnancy tissues,promote the repair of endometrium,alleviate the inflammatory response and reduce the level of PAPP-A.However,low-dose E2V has fewer adverse reactions and is with higher safety.