高强度聚焦超声联合氨甲蝶呤肌内注射对瘢痕妊娠患者卵巢储备功能、血流指数、INH-A、VEGF的影响

Effects of HIFU combined with intramuscular injection of methotrexate on ovarian reserve function,blood flow index,INH-A and VEGF in patients with scar pregnancy

目的探讨高强度聚焦超声(HIFU)联合氨甲蝶呤肌内注射对瘢痕妊娠患者卵巢储备功能及血流指数、抑制素-A(INH-A)、血管内皮生长因子(VEGF)的影响。方法将2019年1月至2020年12月于该院接受清宫术的120例瘢痕妊娠患者按照治疗方式分为对照组和观察组,各60例。对照组给予肌内注射氨甲蝶呤治疗,观察组给予HIFU联合肌内注射氨甲蝶呤治疗,对比两组患者疗效、卵巢储备功能指标、血流指数,以及血清INH-A、VEGF水平。结果观察组术中出血量、月经恢复正常时间及血清人绒毛膜促性腺激素(β-HCG)转阴时间均明显低于或短于对照组(P<0.05)。治疗3个月后观察组血清促卵泡激素(FSH)、促黄体生成素(LH)水平均明显低于对照组(P<0.05),但治疗6个月后两组血清LH、雌二醇(E_(2))水平接近治疗前水平;治疗3、6个月后两组血清LH水平比较,差异均有统计学意义(P<0.05),治疗6个月后两组血清E_(2)水平差异均无统计学意义(P>0.05)。治疗3、6个月后两组血清抗缪勒氏管激素(AMH)水平均持续降低,且观察组血清AMH水平明显高于对照组(P<0.05);治疗3个月后观察组的窦状卵泡计数(AFC)均明显降低,治疗6个月后两组AFC高于治疗前(P<0.05)。治疗3 d及1周后两组最大流速(V_(max))和搏动指数(PI)明显降低(P<0.05),观察组V_(max)和PI均明显低于对照组(P<0.05)。治疗1周后两组血清INH-A和VEGF水平均明显降低(P<0.05),且观察组血清INH-A和VEGF水平均明显低于对照组(P<0.05)。结论HIFU联合氨甲蝶呤治疗瘢痕妊娠可以减少清宫术中出血量,并加快卵巢储备功能恢复。

Objective To investigate the effects of high intensity focused ultrasound(HIFU)combined with intraperitoneal injection of methotrexate on ovarian reserve function,blood flow index,inhibin-A(INH-A)and vascular endothelial growth factor(VEGF)in patients with scar pregnancy.Methods A total of 120 patients with scar pregnancy who received uterine curettage in this hospital from January 2019 to December 2020 were divided into control group and observation group according to treatment methods,with 60 cases in each group.The control group was given intramuscular injection of methotrexate,and the observation group was given HIFU combined with intramuscular injection of methotrexate.The efficacy,ovarian reserve function index,blood flow index,serum INH-A and VEGF levels were compared between the two groups.Results The amount of intraoperative blood loss,the time of menses returning to normal and the time of serum human chorionic gonadotropin(β-HCG)turning negative in the observation group were significantly lower or shorter than those in the control group(P<0.05).Three months after treatment,the serum levels of follicle-stimulating hormone(FSH)and luteinizing hormone(LH)in the observation group were significantly lower than those in the control group(P<0.05),but 6 months after treatment,the serum LH and estradiol(E_(2))levels in the two groups were close to the serum levels before treatment.Three and six months after treatment,there were statistically significant differences in serum LH level between the two groups(P<0.05),but no statistically significant difference on serum E_(2) levels between the two groups(P>0.05).Three and six months after treatment,the serum anti-Mullerian hormone(AMH)level in both groups continued to decrease,and the serum AMH level in observation group was significantly higher than that in control group(P<0.05).Three months after treatment,the number of sinus follicles(AFC)in observation group decreased significantly,and STX months after treatment,the AFC in both group was higher than before treatment(P<0.05).Three days and One week after treatment,the maximum flow rate(V_(max))and pulsatile index(PI)in the two groups decreased significantly(P<0.05),and the V_(max) and PI in the observation group were significantly lower than those in the control group(P<0.05).One week after treatment,the levels of serum INH-A and VEGF in the two groups decreased significantly(P<0.05),and the levels of serum INH-A and VEGF in the observation group were significantly lower than those in the control group(P<0.05).Conclusion HIFU combined with methotrexate in the treatment of scar pregnancy can not only reduce the amount of bleeding during uterine evacuation but also accelerate the recovery of ovarian reserve function.