重度宫腔粘连子宫内膜修复中微血管密度及VEGF的表达及其临床意义  

Clinical significance of VEGF expression and microvessel density in severe intrauterine adhesion patients before and after transcervical resection of adhesion

作　　者：陈玉清[1] 常亚杰[2] 杨欢[1] Yang Huaru;Chang Yajie;Chen Yuqing(Department of Gynecology and Obstetrics, the First Affiliated Hospital o f Sun Yat-sen University, Guangzhou 510080, China)

机构地区：[1]中山大学附属第一医院妇产科,广州510080 [2]中山大学附属第六医院妇产科,广州510600

出　　处：《新医学》2016年第10期671-675,共5页Journal of New Medicine

基　　金：广东省科技计划项目(2013B021800237);广东省自然科学基金(2016A030313187);广州市科技计划项目(201300000169)

摘　　要：目的探讨宫腔镜下宫腔粘连切除术(TCRA)前后微血管密度(MVD)及血管内皮生长因子(VEGF)在重度宫腔粘连子宫内膜表达的差异及其临床意义。方法选择60例重度宫腔粘连患者,其中Ⅳ度宫腔粘连37例、Ⅴ度宫腔粘连23例。所有宫腔粘连患者行TCRA后予雌激素为主的人工周期治疗。检测术前、术后3个月60例患者子宫内膜中CD34标记的MVD及VEGF表达水平。结果 60例患者的手术过程均顺利,术中无一例发生大量出血、水中毒、子宫穿孔等并发症,术后随访均未见盆腔感染。TCRA术前、术后3个月,60例宫腔粘连患者的子宫内膜组织中均有CD34及VEGF表达。TCRA术后3个月患者子宫内膜的MVD、VEGF评分均高于术前(P均<0.01)。术后3个月,Ⅳ度宫腔粘连、月经中期子宫内膜厚度≥7 mm、粘连无复发患者的子宫内膜MVD、VEGF评分均相应高于Ⅴ度宫腔粘连、子宫内膜<7 mm、粘连复发患者(P均<0.01)。结论宫腔粘连子宫内膜修复过程中MVD、VEGF表达上调,提示微血管的新生可能有利于TCRA术后子宫内膜修复。Objective To explore the clinical significance of microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression in endometrium with severe intrauterine adhesion before and after transcervical resection of adhesion (TCRA). Methods Sixty patients diagnosed with severe intrauterine adhesion including 37 cases of grade IV intrauterine adhesion and 23 of grade V intrauterine adhesion were recruitedin this study. All patients underwent TCRA and subsequently received estrogen artificial cycle therapy.The expression levels of CD34-marked MVD and VEGF were quantitatively measured before and 3 months afterTCRA. Results All 60 patients underwent TCRA successfully. Intraoperatively, no patient developed massivehemorrhage, water poisoning, uterine perforation or alternative complications. No pelvic inflammation was observedduring follow-up. Both CD34 and VEGF were expressed in the endometrium of intrauterine adhesion patientsbefore and 3 months after TCRA. At postoperative 3 months, the MVD and VEGF scores were significantlyhigher compared with preoperative scores (both P <0. 01). The MVD and VEGF scores in patients withgrade IV intrauterine adhesion, endometrial thickness^ 7 mm at the middle of the menstrual cycle and no recurrenceof intrauterine adhesion were significantly higher than those in their counterparts with grade V intrauterineadhesion, endometrial thickness <7 mm and no recurrent intrauterine adhesion (both P <0. 01). ConclusionThe expression levels of MVD and VEGF in endometrium are up-regulated after TCRA, prompting that angiogenesis probably contributes to the repair of endometrium.

关 键 词：宫腔粘连 血管内皮生长因子 微血管密度 

分 类 号：R713.4[医药卫生—妇产科学]