金凤丸联合人工周期治疗对宫腔粘连分离术后患者血液流变学和血清因子的影响观察

Effect of Jinfeng Pill Combined with Artificial Cycle Therapy on Hemorheology and Serum Factors in Patients with Intrauterine Adhesions

目的观察金凤丸联合人工周期治疗对宫腔镜宫腔粘连分离术(Trans-cervical resection of adhesions,TCRA)后患者血液流变学和血清因子水平的影响。方法选取2018年6月—2021年5月期间中国人民解放军中部战区总医院收治的60例中重度宫腔粘连(Intrauterine adhesion,IUA)患者作为研究对象,按入院顺序编号后采用随机数字表法分为观察组和对照组,每组各30例。两组患者均接受人工周期干预治疗,观察组联合应用金凤丸。治疗后观察比较两组患者临床疗效及术后再次粘连发生率。比较两组患者治疗前后血液流变学指标[血浆全血黏度、高切黏度、低切黏度、红细胞(Red blood cell,RBC)刚性指数]、血清细胞因子[肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)、纤维连接蛋白(Fibronectin,FN)及血小板源性生长因子(Platelet derived growth factor,PDGF)]水平及子宫动脉血流阻力(Resistance index,RI)和搏动指数(Pulsatility index,PI)及子宫内膜厚度。结果治疗后观察组总有效率100%(30/30)明显优于对照组93.33%(28/30),差异有统计学意义(P<0.05)。治疗后两组患者全血黏度、高切黏度、低切黏度及RBC刚性指数均较治疗前明显降低,差异有统计学意义(P<0.05);且观察组全血黏度、高切黏度、低切黏度及RBC刚性指数均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清TNF-α和PDGF水平均明显低于治疗前,VEGF和FN水平均明显高于治疗前,差异有统计学意义(P<0.05);且观察组血清TNF-α和PDGF水平均明显低于对照组,VEGF和FN水平均高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者RI和PI均较治疗前明显降低,子宫内膜厚度均较治疗前明显升高,差异有统计学意义(P<0.05);且观察组PI明显低于对照组,子宫内膜厚度高于对照组,差异有统计学意义(P<0.05)。治疗后观察组再粘连率3.33%(1/30),对照组再粘连率20.00%(6/30),两组患者再粘连率比较,差异有统计学意义(P<0.05)。结论金凤丸联合人工周期治疗有助于降低TCRA患者术后宫腔再粘连率,这可能与其改善患者血液流变学和血清细胞因子水平有关。

Objective To study the effect of Jinfeng pill combined with artificial cycle therapy on hemorheology and serum factors in patients undergoing transcervical resection of adhesions(TCRA).Methods A total of 60 patientsundergoing TCRA in General Hospital of Central Theater Command of Chinese People′s Liberation Armyfrom June 2018 to May 2021 were collected as the research objects,and they were divided into observation group and control group by random number table according to the admission order number,30 in each group.The two groups received artificial cycle therapy,and on this basis the observation group was treated with Jinfeng pill.The overall clinical efficacy and incidence of postoperative adhesion were compared between the two groups.In addition,the hemorheological indexes[plasma whole blood viscosity,high shear viscosity,low shear viscosity,red blood cell(RBC)rigidity index],serum cytokines[tumor necrosis factor-α(TNF-α),vascular endothelial growth factor(VEGF),fibronectin(FN)and platelet-derived growth factor(PDGF)]and uterine artery blood flow resistance index(RI)and pulsatility index(PI),and endometrial thickness of the two groups were compared before and after intervention.Results The overall efficacy of the observation group was 100%(30/30)better than 93.33%(28/30)of the control group(P<0.05).The whole blood viscosity,high shear viscosity,low shear viscosity and RBC rigidity index as well as TNF-αand PDGF of the two groups after treatment were lower while VEGF and FN were higher than those before treatment(all P<0.05),and the observation group had more reduction or elevation than the control group(P<0.05).The RI and PI of the two groups were decreased while the endometrial thickness was increased compared with those before treatment(P<0.05),and the observation group had more decrease in PI and increase in endometrial thickness than the control group(P<0.05).The re-adhesion rate of the observation group was 3.33%(1/30)lower than 20.00%(6/30)of the control group(P<0.05).Conclusion Jinfeng pill combined with artificial cycle therapy could reduce the rate of intrauterine re-adhesion in patients undergoing TCRA,which might be related to the improvement of hemorheological indexes and serum cytokine levels.