米非司酮联合米索前列醇对稽留流产患者血清和绒毛组织性激素、炎性因子、氧化应激因子的影响

Effects of mifepristonecombined with misoprostol on sex hormones, inflammatory factors, oxidative stress factors in serum and villus tissues of patients with missed abortion

目的研究米非司酮联合米索前列醇对稽留流产患者血清和绒毛组织性激素、炎性因子、氧化应激因子的影响。方法前瞻性选择2019年1月至2020年6月入住安徽皖北煤电集团总医院的MA患者60例,按照随机数字表法将60例患者分为试验组(n=30)与对照组(n=30)。对照组入院1 d给予米非司酮200 mg口服,服药前后禁食2h,第3天将卡前列甲酯栓1 mg经阴道置于后穹窿,1 h后行清宫术。入院1、2 d分别早晚给予米非司酮50、25 mg口服,服药前后禁食2 h,入院3 d晨给予米索前列醇0.6 mg,空腹口服,3 h后行清宫术。观察2组清宫术中出血量、麻醉时间、负压吸引压力、宫腔吸引时间、阴道持续出血时间等手术相关指标,入院时及清宫术前血清和绒毛组织β-绒毛膜促性腺激素(β-h CG)、孕酮(P)、雌二醇(E2)、程序性死亡分子-5(PDCD-5)、白细胞介素-18(IL-18)水平,入院时及清宫术前血清还原型谷胱甘肽(GSH)和氧化型谷胱甘肽(GSSG)、GSH/GSSG、活性氧自由基(ROS)水平和不良反应发生情况。结果试验组清宫术术中出血量、麻醉时间、负压吸引压力、宫腔吸引时间、阴道持续出血时间等均小于对照组,差异均有统计学意义(P <0.05)。入院时,2组血清、绒毛组织β-h CG、P、E2、IL-18、PDCD-5、GSH、GSH/GSSG、GSSG、ROS水平比较,差异均无统计学意义(P> 0.05)。清宫术前,试验组血清、绒毛组织β-h CG、P、E2水平均高于对照组,IL-18、PDCD-5水平均低于对照组(P <0.05)。清宫术前,试验组GSH、GSH/GSSG水平均高于对照组,GSSG、ROS水平低于对照组(P <0.05)。2组不良反应发生率比较,差异无统计学意义(P> 0.05)。结论米非司酮联合米索前列醇可缓解机体炎性及氧化应激反应,调节血清和绒毛组织性激素、炎性因子、氧化应激因子水平,促进胎盘组织脱离,为成功实施清宫手术创造条件。

Objective To study the effects of mifepristone combined with misoprostol on Sex hormones,inflammatory factors,oxidative stress factors in serum and Villus Tissues of patients with missed abortion(MA).Methods From January 2019 to June 2020,60 MA patients admitted to General Hospital of Wanbei Coal Power Group were selected prospectively and divided into experimental group(n=30)and control group(n=30)according to the random number table method.The control group was given 200 mg mifepristone orally 1 d after admission,and fasted for 2 h before and after taking the drug.On the 3 d,methyl carprost was suppository(1 mg)through the vagina and placed in the posterior fornix.At 1 and 2 d after admission,mifepristone 50 and 25 mg orally was given in the morning and evening,respectively.After 2 h of fasting before and after taking the medicine,misoprostol 0.6 mg orally on an empty stomach was given at 3 h after admission.The control group was treated with mifepristone and carprostol,while the experimental group was treated with mifepristone and misoprostol.Intraoperative blood loss,anesthesia time,uterine cavity attract pressure suction pressure,duration,vaginal bleeding time indicators,levels of serum and chorionic tissueβ-chorionic gonadotropin(β-hCG),progesterone(P),estradiol(E2),programmed death molecule-5(PDCD-5),interleukin-18(IL-18),serum levels of reduced glutathione(GSH)and oxidized glutathione(GSSG),GSH/GSSG,reactive oxygen free radicals(ROS)and adverse reactions on admission and before surgery were observed in the two groups.Results The amount of blood loss,anesthesia time,negative pressure suction pressure,uterine cavity suction time and vaginal continuous bleeding time in the experimental group were all less than those in the control group(P<0.05).At the time of admission,there was no statistically significant difference in the levels of serum and chorionicβ-hCG,P,E2,IL-18,PDCD-5,GSH,GSH/GSSG,GSSG,and ROS between the two groups(P>0.05).Before clearing the palace,serum and villus tissues levels of E2,P,β-hCG in the experimental group were higher than those in the control group,and levels of IL-18,PDCD-5 were lower than those in the control group(P<0.05).levels of GSH,GSH/GSSG in the experimental group were higher than those in the control group before clearing the palace,and levels of GSSG and ROS were lower than those in the control group(P<0.05).There was no difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Mifepristone combined with misoprostol can alleviate the inflammatory and oxidative stress response of the body,regulate the Sex hormones,inflammatory factors,oxidative stress factors of serum and Villus Tissues,promote the detachment of placental tissue,and create conditions for the successful implementation of palace clearance surgery.