宫腔粘连分离术后不同干预方案对粘连相关细胞因子表达及临床结局的影响

Effect of different intervention plans on the expression of adhesion related cytokines and clinical outcomes after uterine adhesions separation surgery

目的观察在宫腔粘连分离术(TCRA)后采用不同干预方案对患者粘连相关细胞因子表达水平、月经恢复和临床结局的影响。方法将2022年2月至2023年2月在杭州市临平区第一人民医院接受TCRA手术治疗的180例患者根据术后不同干预方案分为A组、B组和C组,各60例。A组患者术后采用雌孕激素人工周期治疗,在此基础上给予B组患者放置元宫型节育环,给予C组患者宫腔注射透明质酸钠凝胶。比较3组患者术后2个月时宫腔粘连程度分级、月经改善率及术后1年内的妊娠结局。采用荧光定量PCR技术检测各组患者宫腔粘连处子宫内膜组织转化生长因子β1(TGF-β1)、血小板源性生长因子BB(PDGF-BB)、基质金属蛋白酶组织抑制因子-1(TIMP-1)、碱性成纤维细胞生长因子(bFGF)的mRNA相对表达量并进行比较。结果术后2个月时,A组、B组和C组宫腔粘连率分别为43.33%、15.00%和11.67%,B组和C组宫腔粘连率比较差异无统计学意义(P>0.05),但均显著低于A组(P<0.05);同时,B组和C组宫腔粘连程度显著轻于A组(P<0.05)。A组、B组和C组术后2个月时月经改善率分别为76.67%、93.33%和96.67%,B组和C组间比较差异无统计学意义(P>0.05),但均显著高于A组(P<0.05)。A组术后2个月时宫腔粘连处子宫内膜组织中TGF-β1、PDGF-BB、TIMP-1、bFGF mRNA相对表达量分别为0.77±0.26、0.58±0.27、0.54±0.15和0.62±0.14,B组分别为0.37±0.16、0.37±0.14、0.26±0.11和0.29±0.10,C组分别为0.32±0.16、0.21±0.09、0.27±0.08和0.34±0.18,各组细胞因子相对表达量均显著低于术中(P<0.05)。B组和C组术后2个月时各细胞因子mRNA相对表达量比较差异无统计学意义(P>0.05),但均显著低于A组(P<0.05)。A组、B组和C组术后1年内的妊娠成功率分别为40.00%、55.00%和58.33%,C组妊娠成功率显著高于A组(P<0.05)。结论TCRA术后在雌孕激素治疗基础上应用元宫型节育环或透明质酸钠凝胶能有效预防宫腔粘连患者术后再粘连,改善临床症状,降低粘连细胞因子表达水平,两种方案效果相当。

ObjectiveTo observe the effects of different intervention schemes on the expression of adhesion-related cytokines,menstrual recovery and clinical outcome of patients after transcervical resection of adhesion(TCRA).Methods180 patients received TCRA in our hospital from Feb.2022 to Feb.2023 were divided into group A,group B and group C according to different post-operative intervention programs,with 60 patients in each group.Patients in group A were treated with artificial cycle of estrogen and progesterone after surgery.On this basis,patients in group B were placed with a uterine birth control ring,and patients in group C were injected with sodium hyaluronate gel into the uterine cavity.The grade of uterine cavity adhesion,improvement rate of menstruation and pregnancy outcome at 2 months after operation and pregnancy outcome within 1 year after surgery were compared between the three groups at 2 months after operation.The relative mRNA expression of endometrial tissue transforming growth factorβ1(TGF-β1),platelet-derived growth factor BB(PDGF-BB),tissue inhibitor of matrix metalloproteinase-1(TIMP-1)and basic fibroblast growth factor(bFGF)at uterine cavity adhesion in each group were detected and compared.ResultsAt 2 months after surgery,the uterine adhesion rates in group A,group B,and group C were 43.33%,15.00%,and 11.67%,respectively.There was no significant difference in the uterine adhesion rates between group B and group C(P>0.05),but they were significantly lower than those in group A(P<0.05);Meanwhile,the degree of intrauterine adhesions in group B and group C was significantly milder than that in group A(P<0.05).The menstrual improvement rates of group A,group B,and group C at 2 months after surgery were 76.67%,93.33%,and 96.67%,respectively.There was no significant difference between group B and group C(P>0.05),but they were all significantly higher than group A(P<0.05).At 2 months post surgery,the relative expression levels of TGF-β1,PDGF-BB,TIMP-1,and bFGF mRNA in the endometrial tissue at the site of uterine adhesions in group A were 0.77±0.26,0.58±0.27,0.54±0.15,and 0.62±0.14,respectively.In group B,they were 0.37±0.16,0.37±0.14,0.26±0.11,and 0.29±0.10,respectively.In group C,they were 0.32±0.16,0.21±0.09,0.27±0.08,and 0.34±0.18,respectively.The relative expression levels of cytokines in each group were significantly lower than during surgery(P<0.05).There was no significant difference in the relative expression levels of various cytokines mRNA between group B and group C at 2 months after surgery(P>0.05),but both were significantly lower than group A(P<0.05).The pregnancy success rates within 1 year after surgery in group A,group B,and group C were 40.00%,55.00%,and 58.33%,respectively.The pregnancy success rate in group C was significantly higher than that in group A(P<0.05).ConclusionsThe application of metauterine contraceptive ring or sodium hyaluronate gel on the basis of estrogen and progesterone treatment after TCRA can effectively prevent postoperative re-adhesion of patients with intrauterine adhesions,improve clinical symptoms,and reduce the expression level of adhesion cytokines.The effects of the two schemes are equivalent.