子宫动脉栓塞术联合甲氨蝶呤不同给药方式治疗剖宫产术后子宫瘢痕妊娠疗效及对HOXA11蛋白的影响  

Efficacy of uterine artery embolization combined with different administration methods of methotrexate in the treatment of cesarean scar pregnancy after cesarean section and its effect on HOXA11 protein

作　　者：宋渊丽 李引弟[1] 邵芳[2] Song Yuanli;Li Yindi;Shao Fang(The Second Obstetrics Ward,Yan'an University Affiliated Hospital,Yan'an 716000,China;Department of Obstetrics,Xi'an Aerospace General Hospital,Xi'an 710100,China)

机构地区：[1]延安大学附属医院产科二病区,延安716000 [2]西安航天总医院产科,西安710100

出　　处：《广西医科大学学报》2020年第7期1292-1296,共5页Journal of Guangxi Medical University

摘　　要：目的:探究子宫动脉栓塞术(uterine artery embolization,UAE)联合甲氨蝶呤(methotrexate,MTX)不同给药方式对剖宫产术后子宫瘢痕妊娠(cesarean scar pregnancy,CSP)疗效及对HOXA11蛋白的影响。方法:回顾性分析2018年1月至2019年6月延安大学附属医院收治的113例CSP患者临床资料,根据术前MTX不同给药方式将其分为术前肌注组(n=36)、术中局部注射组(n=37)以及术后静脉注射组(n=40)。比较各组治疗期间的不良反应发生情况,同时检测各组术后人绒毛膜促性腺激素β亚单位(β-hCG)、HOXA11蛋白、妊娠组织与子宫瘢痕肌壁间血流阻力指数(RI)及剖宫产瘢痕肌层(CSM)的差异。结果:术后3 d、1周和2周,术前肌注组β-HCG下降率均明显高于术中局部注射组及术后静脉注射组(P<0.05),而HOXA11表达量则低于其余两组(P<0.05);术前肌注组CSM、RI均明显高于术中局部注射组及术后静脉注射组(P<0.05);术前肌注组转氨酶升高、白细胞下降、恶心呕吐等不良反应发生率均明显低于术中局部注射组及术后静脉注射组(P<0.05)。结论:UAE手术前肌肉注射MTX治疗CSP,更有助于促进患者血β-HCG水平下降,调节HOXA11表达水平,改善患者RI及CSM厚度,疗效显著且安全性较高。Objective: To explore the effect of uterine artery embolization(UAE) combined with methotrexate(MTX) on the cesarean scar pregnancy(CSP) after cesarean section and its impact on the HOXA11 protein.Methods: The clinical data of 113 CSP patients admitted to the Affiliated Hospital of Yan’an University from January 2018 to June 2019 were retrospectively analysis, and the patients were divided into preoperative intramuscular injection group(n=36), intraoperative local injection group(n=37), and postoperative intravenous injection group(n=40) according to the method of MTX administration before treatment. The occurrence of adverse reactions during treatment in each group was observed. Detection and comparison of human chorionic gonadotropin βsubunit(β-hCG), HOXA11 protein, blood flow resistance index(RI) between the pregnancy tissue and the uterine scar muscle, wall as well as cesarean scar myometrium(CSM) after operation in each group. Results: At 3 days, 1 week, and 2 weeks after treatment, theβ-HCG decline rate in preoperative intramuscular injection group was significantly higher than that in the intraoperative local injection group and postoperative intravenous injection group(P<0.05), while the HOXA11 expression in preoperative intramuscular injection group was lower than the other two groups(P<0.05);the CSM and RI in the preoperative intramuscular injection group were significantly higher than those in the intraoperative local injection group and the postoperative intravenous injection group(P<0.05);the incidence of adverse reactions such as elevated transaminase, decreased white blood cells,nausea and vomiting in the preoperative intramuscular injection group were significantly lower than those in the intraoperative local injection group and postoperative intravenous injection group(P<0.05). Conclusion: Intramuscular injection of MTX before UAE in the treatment of CSP can help to reduce blood β-HCG level,regulate the expression level of HOXA11, improve the RI and CSM thickness, with a significant effect

关 键 词：子宫动脉栓塞术 甲氨蝶呤 不同给药方式 剖宫产 子宫瘢痕妊娠 

分 类 号：R714.22[医药卫生—妇产科学]