稽留流产清宫术后去氧孕烯炔雌醇辅助治疗对子宫内膜组织MMP9、TGF-β3 mRNA水平及内膜修复效果

Influence of desogestrel and ethinyl estradiol used for adjuvant therapy after curettage in women with missed abortion on their MMP9 and TGF-β3 mRNA levels in endometrial tissue and the effect of endometrial repair

目的:探究去氧孕烯炔雌醇辅助治疗稽留流产清宫术后对患者子宫内膜损伤修复效果及甘油三脂-β3(TGF-β3)、基质金属蛋白酶9(MMP9)水平变化。方法:收集2019年1月—2020年12月本院行稽留流产清宫术后药物干预160例临床资料,统计术后流产不全、闭经及宫颈粘连等并发症,子宫内膜厚度、阴道出血时间及月经复潮时间,分析TGF-β3、MMP9 mRNA表达,及其各指标相关性及预测疗效价值。结果:术后宫颈粘连发生率为10.0%,阴道出血时间(3.1±1.8d)、月经复潮时间(26.9±2.7d)及子宫内膜厚度(2.4±0.7mm)均有明显改善,患者子宫内膜组织中MMP-9(0.931±0.026)、TGF-β3(0.939±0.024)表达下降(均P<0.05);子宫内膜组织中MMP9、TGF-β3水平与并发症及子宫内膜厚度具有相关性,应用MMP9,TGF-β3联合病理指标评估术后干预效果有一定临床价值(AUC=0.852),敏感度89.4%、特异度86.5%。结论:采用去氧孕烯炔雌醇辅助治疗稽留流产术后,能显著降低并发症,降低纤维化因子,有效改善子宫内膜损伤程度,促进术后恢复。

Objective:To explore the repair effect of desogestrel and ethinyl estradiol used for adjuvant therapy of women after curettage because of missed abortion,and to study the changes of their levels of MMP9 and TGF-β3.Methods:The clinical data of 160 women after curettage because of missed abortion from January 2019 to December 2020 were collected.The postoperative complications,such as incomplete miscarriage,amenorrhea,and cervical adhesions,and the endometrial thickness,the vaginal bleeding time,and the time of menstrual recovery of the women were statistics analysed.The TGF-β3 and MMP9mRNA expression levels,and the correlation and the predictive value of which were also analyzed.Results:The rate of postoperative cervical adhesions(10.0%),the vaginal bleeding time(3.1±1.8 d),the time of menstrual recovery(26.9±2.7 d),and the endometrial thickness(2.4±0.7 mm)of the women had obviously improved after treatment.The levels of MMP-9(0.931±0.026)and TGF-β3(0.939±0.024)in endometrial tissue of the women had decreased significantly after treatment(all P<0.05).The levels of MMP-9 and TGF-β3 in endometrial tissue of the women were associated with their complications rate and endometrial thickness.The levels of MMP-9 and TGF-β3 combined with the complications and endometrial thickness of the women for evaluating the efficacy of postoperative treatment had certain clinical value(AUC=0.852),which sensitivity and specificity were 89.4%and 86.5%.Conclusion:Desogestrel and ethinyl estradiol used for adjuvant therapy of women after curettage because of missed abortion can significantly reduce the incidence of complicatios and fibrosis factor levels,can effectively alleviate the severity of endometrial injury after curettage,and can improve postoperative recovery.