阿司匹林联合盆底平滑肌电刺激对宫腔粘连分离术后患者子宫内膜MVD和VEGF表达的影响及其临床意义

doi:10.13481/j.1671-587x.20190636

摘要/Abstract

摘要： 目的：观察宫腔粘连分离术后阿司匹林联合盆底平滑肌电刺激对宫腔粘连（IUA）患者子宫内膜的影响，阐明其对IUA患者术后新生血管形成及血液循环的改善作用。方法：80例中重度IUA并有生育意愿的患者随机分为对照组、药物组、电刺激组和联合组（n=20），均行宫腔镜下宫腔粘连分离术。其中对照组患者行雌孕激素序贯疗法，药物组患者行雌孕激素序贯疗法+阿司匹林治疗，电刺激组患者行雌孕激素序贯疗法联合盆底平滑肌电刺激治疗，联合组患者行雌孕激素序贯疗法+阿司匹林联合盆底平滑肌电刺激治疗。比较各组患者治疗前后疗效，观察各组IUA患者术后子宫内膜厚度（ET）、搏动指数（PI）、阻力指数（RI）、妊娠情况和子宫内膜微血管密度（MVD）值，RT-qPCR法和Western blotting法检测各组IUA患者子宫内膜组织中血管内皮生长因子（VEGF） mRNA和蛋白表达水平。结果：联合组IUA患者总有效率明显高于对照组（P<0.05）。与治疗前比较，治疗后药物组、电刺激组和联合组IUA患者ET明显增加（P<0.05），PI和RI明显降低（P<0.05）；治疗后联合组IUA患者PI和RI明显低于对照组、药物组和电刺激组（P<0.05）。与治疗前比较，治疗后电刺激组和联合组IUA患者子宫内膜MVD值明显升高（P<0.05），治疗后联合组IUA患者子宫内膜MVD明显高于对照组、药物组和电刺激组（P<0.05）。与治疗前比较，治疗后对照组、药物组、电刺激组和联合组IUA患者子宫内膜组织中VEGF mRNA和蛋白表达水平明显升高（P<0.05），治疗后联合组IUA患者子宫内膜组织中VEGF mRNA和蛋白水平明显高于对照组、药物组和电刺激组（P<0.05）。结论：宫腔粘连分离术后使用阿司匹林联合盆底平滑肌电刺激可以明显改善患者ET并增加子宫血液循环。

关键词: 宫腔粘连, 盆底平滑肌电刺激, 微血管密度, 血管内皮生长因子, 阿司匹林

Abstract: Objective: To observe the effects of aspirin combined with electrical stimulation of pelvic floor smooth muscle on the endometrium of the intrauterine adhesion(IUA) patients after hysteroscopic adhesiolysis, and to clarify its improvement effect on the neovascularization and blood circulation after operation of the IUA patients. Methods: Eighty patients with moderate or severe IUA, having fertility intention, were divided into control group, drug group, electrical stimulation group and combination group(n=20), and all the patients underwent hysteroscopic adhesidysis. The patients in control group were treated with estrogen progesterone sequential therapy,the patients in drug group were treated with estrogen progesterone sequential therapy plus aspirin, the patients in electrical stimulation group were treated with estrogen progesterone sequential therapy combined with pelvic floor smooth muscle stimulation,and the patients in combination group were treated with estrogen progesterone sequential therapy plus aspirin combined with pelvic floor smooth muscle stimulation. The efficacies of patients in various groups before and after treatment were compared, and the endometrium thickness (ET), pulsatility index (PI), resistance index (RI), pregnancy status,and the endometrium microvessel density (MVD) values of the IUA patients in various groups were observed;the expression levels of vascular endothelial growth factor (VEGF) mRNA and protein in endometrial tissue of the IUA patients in various groups were detected by RT-qPCR and Western blotting methods. Results: The total effective rate of patients in combination group was significantly higher than those in control group, drug group and electricalal stimulation group(P<0.05). Compared with before treatment, the ET of the IUA patients in drug group, electrical stimulation group and combination group after treatment were increased significantly (P<0.05), and PI and RI were decreased significantly (P<0.05);after treatment,the PI and RI of the IUA patients in combination group were significantly lower than those in control group, drug group and electrical stimulation group (P<0.05). Compared with before treatment, the endometrium MVD values of the IUA patients in electrical stimulation group and combination group after treatment were increased significantly (P<0.05); the endometrium MVD value of the IUA patients in combination group was significantly higher than those in control group, drug group and electrical stimulation group (P<0.05). Compared with before treatment, the expression levels of VEGF mRNA and protein in endometrial tissue of the IUA patients in control group, drug group, electrical stimulation group and combination group after treatment were significantly increased (P<0.05); after treatment, the expression levels of VEGF mRNA and protein of the IUA patients in combination group were significantly higher than those in control group, drug group and electricalal stimulation group (P<0.05). Conclusion: Aspirin combined with electrical stimulation pelvic floor smooth muscle can significantly improve the ET of the patients, and increase the uterine blood circulation after hysterocopic adhesiolysis.

Key words: uterine cavity adhesion, electrical stimulation of pelvic floor smooth muscle, microvascular density, vascular endothelial growth factor, aspirin

中图分类号:

R711.32

刘静乔, 郑燕, 王玉静, 孟亚丽, 徐淑稳, 张华林. 阿司匹林联合盆底平滑肌电刺激对宫腔粘连分离术后患者子宫内膜MVD和VEGF表达的影响及其临床意义[J]. 吉林大学学报(医学版), 2019, 45(06): 1408-1414.

LIU Jingqiao, ZHENG Yan, WANG Yujing, MENG Yali, XU Shuwen, ZHANG Hualin. Effects of aspirin combined with electrical stimulation of pelvic floor smooth muscle on MVD and VEGF expression in endometrium of patients after hysteroscopic adhesiolysis and its clinical significance[J]. Journal of Jilin University(Medicine Edition), 2019, 45(06): 1408-1414.

参考文献

[1] 周琴琴, 金群俏. COOK球囊预防中重度宫腔粘连疗效分析[J]. 浙江中西医结合杂志, 2018, 28(1):46-49.
[2] KHAN Z, GOLDBERG J M. Hysteroscopic management of Asherman's syndrome: special issue report on uterine surgery in the journal of minimally invasive gynecology[J]. J Minim Invasive Gynecol, 2018, 25(2): 218-228.
[3] 丁卫, 刘嘉茵. 宫腔粘连术后的生育管理[J]. 实用妇产科杂志, 2017, 33(10):735-737.
[4] LIU A Z, ZHAO H G, GAO Y, et al. Effectiveness of estrogen treatment before transcervical resection of adhesions on moderate and severe uterine adhesion patients[J]. Gynecol Endocrinol, 2016, 32(9):737-740.
[5] 石冬梅, 杨芳, 汪宏玲. 盆底神经肌肉电刺激改善薄型子宫内膜患者子宫内膜厚度及血流灌注分析[J]. 心理医生, 2017, 23(29): 116-118.
[6] 关铮.现代宫腔镜诊断治疗学[M].北京:人民军医出版社,2001:113-148.
[7] ZHU H Y, GE T X, PAN Y B, et al. Advanced role of hippo signaling in endometrial fibrosis: implications for intrauterine adhesion[J]. Chin Med J, 2017, 130(22):2732-2737.
[8] 杨峥莉, 刘荣霞, 郝国荣. PDGF、TGF-β在宫腔粘连患者子宫内膜中的表达[J]. 河北医药, 2013, 35(16):2460-2461.
[9] 慕庆玲, 肖松舒, 万亚军. 生长因子在宫腔粘连形成中的作用[J]. 中国妇产科临床杂志, 2014, 15(3): 286-288.
[10] VERHEUL HM, JORNA A S, HOEKMANK, et al. Vascular endothelial growth factor-stimulated endothelial cells promote adhesion and activation of platelets[J]. Blood, 2000, 96(13):4216-4221.
[11] 韩燕华, 王晶晶, 孙世君,等. 血管内皮生长因子在宫腔粘连患者子宫内膜中的表达[J]. 中国生育健康杂志, 2010, 21(4):208-210.
[12] 方瑾, 张宋玲, 罗泳仪. 宫腔镜下宫腔粘连分离术对宫腔形态恢复和月经改善的影响[J]. 中国妇幼保健, 2017, 32(9):2022-2024.
[13] CAI HH, QIAO L, SONG K J, et al. Oxidized, regenerated cellulose adhesion barrier plus intrauterine device prevents recurrence after adhesiolysis for moderate to severe intrauterine adhesions[J]. J Minim Invasive Gynecol, 2017, 24(1):80-88.
[14] 郑雪群, 明芳. 小剂量阿司匹林对宫腔粘连术后子宫动脉血流和子宫内膜的影响[J]. 当代医学, 2018, 24(18):146-148.
[15] HEALY M W, SCHEXNAYDER B, CONNELL M T, et al. Intrauterine adhesion prevention after hysteroscopy: a systematic review and meta-analysis[J]. Am J Obstet Gynecol, 2016, 215(3):267-275,e7.
[16] AMER M I, ABD-EL-MAEBOUD K, ALLOUB A. Amnion graft as a possible source of stem cells for endometrial regeneration after lysis of severe intrauterine adhesions[J]. Mid East Fertil Soc J, 2012, 17(1):54-56.
[17] CHEN Q W, LIANG Q X, LI X C, et al. Effect of transcervical resection of adhesion combined with low-dose aspirin on uterine artery blood flow and Smad2/3 in endometrial tissue[J]. J Hainan Med Univ, 2016, 22(22): 9-13.
[18] WANG H W, CHAO P Z, LEE F P. Enhanced basal tension in isolated rat tracheal smooth muscle stimulated by electric field stimulation under low temperature[J]. Int J Med Sci, 2018,15(14): 1611-1615.
[19] 张洁, 王影, 冯艳霞, 等. 血管平滑肌电刺激技术治疗外阴上皮内非瘤样病变疗效观察[J]. 中国实用妇科与产科杂志, 2017, 33(1):125-128.
[20] 董云峰, 赵秀峰, 徐晓阳. 电刺激对C2C12肌管自由基代谢及Nrf2/ARE信号通路的影响[J]. 中国运动医学杂志, 2017, 36(12): 1066-1071.