芬吗通和坤泰胶囊对稽留流产清宫术后子宫内膜容受性及血清β-EP和ENK的影响

Effects of Fenmotong and Kuntai Capsules on endometrial receptivity and serumβ-EP,ENK after missed abortion

目的探讨芬吗通和坤泰胶囊对稽留流产清宫术后子宫内膜容受性及血清β-内啡肽(β-EP)和脑啡肽(ENK)的影响。方法前瞻性选择2018年10月至2020年6月沧州市人民医院收治的稽留流产育龄妇女患者共160例为研究对象,按照随机数字表法将其分为观察组与对照组2组,每组各80例。观察组给予芬吗通与坤泰胶囊联合用药,在疗程的1~14 d内服用砖红色芬吗通片,后14 d服用米黄色芬吗通片1粒,在此基础上,每日服用坤泰胶囊4粒/次,28 d为一个疗程。对照组则仅服用坤泰胶囊进行治疗。治疗期间观察2组的手术基本情况;比较2组术后3个月的子宫内膜厚度、子宫的搏动指数(PI)、阻力指数(RI)、子宫内膜的容受性评分(Salle)、细胞因子、性激素[黄体生成激素(LH)、卵泡生成激素(FSH)、抗苗勒氏管激素(AMH)、雌二醇(E2)]水平;清宫手术后随访1年,统计2组患者的不孕症发生率。结果2组的手术时间与术中的出血量比较,差异无统计学意义(P>0.05),观察组手术后的阴道出血时间、月经再来潮时间为(3.55±1.12)d、(28.12±3.22)d,均明显短于对照组[(5.64±1.99)d、(35.69±4.60)d],差异均有统计学意义(P<0.05)。观察组的子宫内膜厚度、Salle评分为(7.32±1.42)mm、(16.85±3.22)分,高于对照组[(4.13±1.35)mm、(10.23±2.02)分],PI、RI为1.55±0.27、0.66±0.03,低于对照组(2.35±0.24、0.96±0.14),差异均有统计学意义(P<0.05)。观察组的血清LH及FSH水平分别为(9.14±2.14)、(17.04±3.41)U/L,明显低于对照组[(14.42±3.08)、(22.57±4.07)U/L],AMH及E2水平为(1.32±0.23)ng/mL、(55.34±6.25)ng/L,高于对照组[(1.04±0.17)ng/mL、(34.25±4.68)ng/L],差异均有统计学意义(P<0.05)。观察组的血清β-EP及ENK水平(13.85±5.80)、(17.53±3.07)pg/mL,显著低于对照组[(16.17±8.48)、(20.03±3.54)pg/mL],差异均有统计学意义(P<0.05)。观察组的不孕症率(3.75%)低于对照组(25.00%),差异有统计学意义(P<0.05)。结论与单纯应用坤泰胶囊相比,芬吗通联合坤泰胶囊干预稽留流产术后患者的治疗效果较好,增强了子宫内膜容受性,改善卵巢储备功能,并降低血清β-EP及ENK水平,减少术后不孕症的发生,可为临床清宫术后稽留流产不孕症治疗提供参考。

Objective To investigate the effects of Fenmatong and Kuntai Capsules on endometrial receptivity and serumβ-endorphin(β-EP)and enkephalin(ENK)after missed abortion and uterine evacuation.Methods A total of 160 missed abortion female patients of childbearing age admitted to Cangzhou People's Hospital from October 2018 to June 2020 were prospectively selected as the research objects,and they were divided into observation group and control group according to the random number table method,80 cases in each group.The observation group was given a combination of fenmetone and Kuntai capsules,taking brick red fenmetone tablets within 1-14 days of the course of treatment,and 1 beige fenmetone tablet for the next 14 days.On this basis,take Kuntai capsules daily.Thai capsules 4 capsules/time,28 days as a course of treatment.The control group only took Kuntai capsule for treatment.During the treatment period,the basic operation conditions of the two groups were observed;the endometrial thickness,uterine pulsatility index(PI),resistance index(RI),and endometrial receptivity score(Salle),cytokines,sex hormones[luteinizing hormone(LH),follicle-forming hormone(FSH),anti-Müllerian hormone(AMH),estradiol(E2)]levels of the two groups at 3 months after surgery were compared;followed up for 1 year after uterine evacuation,the incidence of infertility in the two groups was counted.Results There was no statistically significant difference between the operation time of the two groups and the amount of bleeding during the operation(P>0.05).The vaginal bleeding time and menstrual cramps after the operation in the observation group were(3.55±1.12),(28.12±3.22)d,which were significantly shorter than those in the control group[(5.64±1.99),(35.69±4.60)d],the differences were statistically significant(P<0.05).The endometrial thickness and Salle score in the observation group were(7.32±1.42)mm and(16.85±3.22)points,which were higher than those in the control group[(4.13±1.35)mm,(10.23±2.02)points],PI and RI were 1.55±0.27,0.66±0.03,which were lower than those in the control group(2.35±0.24,0.96±0.14),the differences were statistically significant(P<0.05).Th levels of serum LH and FSH in the observation group were(9.14±2.14)and(17.04±3.41)U/L,which were significantly lower than those in the control group[(14.42±3.08),(22.57±4.07)U/L],the levels of AMH and E2 were(1.32±0.23)ng/mL,(55.34±6.25)ng/L,which were higher than those in the control group[(1.04±0.17)ng/mL,(34.25±4.68)ng/L],and the differences were statistically significant(P<0.05).The levels of serumβ-EP and ENK in the observation group were(13.85±5.80),(17.53±3.07)pg/mL,which were significantly lower than those in the control group[(16.17±8.48),(20.03±3.54)pg/mL],and the differences were statistically significant(P<0.05).The infertility rate of the observation group(3.75%)was lower than that of the control group(25.00%),and the difference was statistically significant(P<0.05).Conclusion Compared with the pure application of Kuntai Capsules,the treatment effect of fenmetone combined with Kuntai Capsules for patients after missed abortion is better,enhancing endometrial receptivity,improving ovarian reserve,and reducing serumβ-EP and ENK Therefore,it can reduce the occurrence of postoperative infertility,which can provide reference for the treatment of missed abortion infertility after clinical uterine evacuation.