输卵管通液术联合溴隐亭治疗高催乳素血症所致不孕症合并输卵管阻塞疗效及其对患者血清促黄体激素、抗顶体蛋白酶抗体的影响

Therapeutic effect of hydrotubation combined with bromocriptine in treatment of infertility patients caused by hyperprolactinemia complicated with tubal obstruction and its effect on serum luteinizing hormone and anti-acrosin antibody

目的探讨输卵管通液术联合溴隐亭对高催乳素血症(HPRL)所致不孕症合并输卵管阻塞患者的临床治疗效果,以及对患者血清促黄体激素(LH)、抗顶体蛋白酶抗体(AcrAb)水平的影响。方法选择2017年6月至2018年6月,绵阳市中心医院收治的HPRL所致不孕症合并输卵管阻塞患者102例为研究对象。采用随机数字表法,将其分为观察组(n=51)和对照组(n=51)。对观察组患者采取输卵管通液术联合溴隐亭治疗,而对照组患者仅采取输卵管通液术治疗。分别采用化学发光法、酶联免疫吸附试验,检测患者血清LH、AcrAb水平。治疗结束后,对2组患者随访1年,观察其妊娠情况。2组患者采取输卵管通液术治疗的持续时间、术中出血量和术后下床活动时间,血清LH、AcrAb水平,以及治疗结束至妊娠的时间比较,采用成组t检验。2组患者输卵管阻塞治疗的总有效率、不良反应率、术后妊娠率比较,采用χ^2检验。本研究经过绵阳市中心医院伦理委员会批准(审批文号:S-2018-022),与所有患者签署临床研究知情同意书。2组患者年龄、不孕年限等一般临床资料比较,差异均无统计学意义(P>0.05)。结果①2组患者采取输卵管通液术治疗的持续时间、术中出血量和术后下床活动时间分别比较,差异均无统计学意义(P>0.05)。②观察组输卵管阻塞治疗的总有效率为82.3%(42/51),显著高于对照组的64.7%(33/51),并且差异有统计学意义(χ^2=4.080、P=0.043)。③组间比较:治疗后,观察组患者血清LH水平为(5.59±0.58)IU/L,显著高于对照组的(5.36±0.57)IU/L,血清AcrAb水平为(12.2±2.5)U/L,显著低于对照组的(14.2±2.9)U/L,并且差异均有统计学意义(t=2.002、P=0.048,t=3.743、P<0.001)。组内比较:治疗后,2组患者血清LH水平,均显著高于治疗前,而血清AcrAb水平,则均显著低于治疗前,并且差异均有统计学意义(P<0.05)。④治疗结束后的1年随访期内,观察组妊娠率为70.6%(36/51),显著高于对照组的51.0%(26/51),治疗结束至妊娠的时间为(4.0±1.0)个月,显著短于对照组的(5.3±1.1)个月,2组分别比较,差异均有统计学意义(χ^2=4.110、P=0.043,t=6.053、P<0.001)。⑤2组治疗相关不良反应率比较,差异无统计学意义(P>0.05)。结论输卵管通液术联合溴隐亭治疗HPRL所致不孕症合并输卵管阻塞患者的疗效较好,患者妊娠率增高,可有效改善患者血清LH、AcrAb水平,不增加不良反应率。由于本研究纳入样本量相对较小,该方案治疗疗效仍有待大样本、多中心、随机对照试验进一步研究、证实。

Objective To explore the clinical effect of hydrotubation combined with bromocriptine in treatment of infertility patients caused by hyperprolactinemia(HPRL)and complicated with tubal obstruction,and its effect on serum luteinizing hormone(LH)and anti-acrosin antibody(AcrAb).Methods A total of 102 patients with infertility caused by HPRL and complicated with tubal obstruction in Mianyang Central Hospital from June 2017 to June 2018 were selected as research subjects.They were randomly divided into observation group(n=51)and control group(n=51)by random digits table method.Patients in observation group were treated with hydrotubation combined with bromocriptine.And patients in control group were treated with hydrotubation.The levels of serum LH and AcrAb were detected by chemiluminescence method and enzyme-linked immunosorbent assay.After treatment,the two groups were followed up for 1 year to observe their pregnancy situation.Duration of hydrotubation,intraoperative blood loss and postoperative ambulation time,levels of serum LH and AcrAb,and the time from the end of treatment to pregnancy between two groups were compared by independent-samples t test.Total effective rates of tubal obstruction,adverse reaction and pregnancy between two groups were compared by chi-square test.This study was approved by the Ethics Committee of Mianyang Central Hospital(Approval No.S-2018-022),and clinical research informed consent was signed with each patient.There were no significant differences in age,duration of infertility and other general clinical data between two groups(P>0.05).Results①There were no significant differences in duration of hydrotubation,intraoperative blood loss and postoperative ambulation time between two groups(P>0.05).②The total effective rate of tubal obstruction in observation group was 82.3%(42/51),which was significantly higher than that of control group 64.7%(33/51),and the difference was statistically significant(χ^2=4.080,P=0.043).③Comparisons between two groups:after treatment,the serum LH level of observation group was(5.59±0.58)IU/L,which was significantly higher than those of control group(5.36±0.57)IU/L,and the serum AcrAb levels were(12.2±2.5)U/L,which was significantly lower than those of control group(14.2±2.9)U/L,and both the differences were statistically significant(t=2.002,P=0.048;t=3.743,P<0.001).Intra-group comparisons:after treatment,serum LH levels in two groups were significantly higher than those before treatment within group,while serum AcrAb levels were significantly lower than those before treatment within group,and all the differences were statistically significant(P<0.05).④During 1-year follow-up after treatment,the pregnancy rate in observation group was 70.6%(36/51),which was significantly higher than that in control group 51.0%(26/51),the time from the end of treatment to pregnancy was(4.0±1.0)months,which was significantly shorter than that of control group(5.3±1.1)months,and both the differences were statistically significant(χ^2=4.110,P=0.043;t=6.053,P<0.001).⑤There was no significant difference in rate of adverse reaction related with treatment between two groups(P>0.05).Conclusions Hydrotubation combined with bromocriptine in treatment of patients with infertility caused by HPRL complicated with tubal obstruction has a good effect,and the pregnancy rate is increased.It can effectively improve serum levels of LH and AcrAb,but does not increase the rate of adverse reactions.Due to the relatively small sample size included in this study,the therapeutic effect of this regimen remains to be further confirmed by large-sample size,multi-center and randomized controlled trials.