盆底肌肉锻炼结合神经肌肉刺激对PFD者RLX、TIMP-2及ET-1的影响

Effect of pelvic floor muscle exercise combined with neuromuscular stimulation on RLX,TIMP-2 and ET-1 in PFD patients

目的 分析盆底肌肉锻炼结合神经肌肉刺激对初产妇产后盆底功能障碍性疾病(PFD)松弛素(RLX)、金属蛋白酶组织抑制因子-2(TIMP-2)及内皮素-1(ET-1)的影响。方法 收集2017年5月至2020年5月衡水市第二人民医院收治的125例PFD患者,根据不同治疗方式分为联合组(盆底肌肉锻炼+神经肌肉刺激)68例、对照组(神经肌肉刺激)57例。比较两组治疗前后3个月盆底肌情况、盆腔松弛因子[RLX、转化生长因子-β3(TGF-β3)、层粘连蛋白(LN)]、TIMP-2、基质金属蛋白酶-2(MMP-2)、一氧化氮(NO)、ET-1、炎性因子[C反应蛋白(CRP)、白介素-6(IL-6)]变化。结果 治疗后联合组总肌电值、Ⅰ类、Ⅱ类肌纤维肌电值均高于对照组,差异有统计学意义(P<0.05)。治疗后联合组RLX、TGF-β3及LN低于对照组,差异有统计学意义(P<0.05)。治疗后联合组MMP-2水平明显低于对照组,TIMP-2高于对照组,差异有统计学意义(P<0.05)。治疗后两组NO水平均上升,炎性因子、ET-1水平下降,且联合组NO水平明显高于对照组,CRP、IL-6、ET-1水平明显低于对照组,差异有统计学意义(P<0.05)。结论 盆底肌肉锻炼结合神经肌肉刺激可有效改善PFD患者盆底功能障碍,降低RLX、ET-1水平,提高TIMP-2表达,临床使用价值高。

Objective To analyze the effects of pelvic floor muscle exercise + neuromuscular stimulation on relaxin(RLX),tissue inhibitor of metalloproteinase-2(TIMP-2),Endothelin-1(ET-1)in postpartum pelvic floor dysfunction(PFD)patients. Methods A total of 125 PFD patients admitted to the Second People ’ s Hospital of Hengshui City from May 2017 to May 2020 were collected,and according to different treatment methods,they were divided into a combination group(pelvic floor muscle exercise +neuromuscular stimulation)68 cases and a control group(neuromuscular stimulation)57 cases. The pelvic floor muscles,pelvic relaxation factor[RLX,transforming growth factor-β3(TGF-β3),laminin(LN)],TIMP-2,matrix metalloproteinase-2(MMP-2),nitric oxide(NO),ET-1,inflammatory factor levels[C-reactive protein(CRP),interleukin-6(IL-6)]change were compared between the two groups before and after 3 months of treatment. Results After treatment,the total EMG,class I,and class II muscle fiber EMG values in the combined group were higher than those in the control group,and the difference was statistically significant(P<0.05). After treatment,RLX,TGF-β3 and LN in the combined group were lower than those in the control group,and the difference was statistically significant(P<0.05). The level of MMP-2 in the combination groupwas significantly lower than that in the control group after treatment,and TIMP-2 was higher than that in the control group,and the difference was statistically significant(P<0.05). After treatment,the level of NO in the two groups increased,and the levels of inflammatory factors and ET-1 decreased. The levels of NO in the combined group were significantly higher than those in the control group,and the levels of CRP,IL-6,and ET-1 were significantly lower than those in the control group,and the difference was statistically significant(P<0.05). Conclusion Pelvic floor muscle exercise combined with neuromuscular stimulation can effectively improve pelvic floor dysfunction of PFD in patients,reduce the levels of RLX and ET-1,and increase the expression of TIMP-2,with high clinical value.