血清TGF-β1、MMP-9和TIMP-1对子宫内膜息肉切除术后发生宫腔粘连的预测价值  

Predictive Value of Serum TGF-β1,MMP-9 and TIMP-1 in Intrauterine Adhesion after Endometrial Polypectomy

作　　者：汪义泳 杜景云[1] 管玉宇 周士华[1] 余木兰[1] 顾群[1] 徐春香 方婷婷[1] WANG Yiyong;DU Jingyun;GUAN Yuyu;ZHOU Shihua;YU Mulan;GU Qun;XU Chunxiang;FANG Tingting(Department of Obstetrics and Gynecology,Luodian Hospital of Shanghai Baoshan District,Shanghai 201908,China)

机构地区：[1]上海市宝山区罗店医院妇产科,上海201908

出　　处：《中国医药导刊》2023年第1期61-66,共6页Chinese Journal of Medicinal Guide

摘　　要：目的:筛选子宫内膜息肉切除术后发生宫腔粘连的影响因素,并探讨血清转化生长因子β1(TGF-β1)、基质金属蛋白酶-9(MMP-9)和金属蛋白酶抑制因子-1(TIMP-1)水平在预测术后2年内发生宫腔粘连的诊断价值。方法:选择2016年1月至2019年6月在我院实施宫腔镜子宫内膜息肉切除术的患者341例,术后对所有患者均进行2年的随访,期间失访23例。术后2年出现宫腔粘连53例,为宫腔粘连组;未发生宫腔粘连患者265例,为非宫腔粘连组。采用酶联免疫吸附试验测定患者术前的血清TGF-β1、MMP-9和TIMP-1表达水平。通过单因素分析和多因素二元Logistics回归分析筛选出与宫腔镜子宫内膜息肉切除术后发生宫腔粘连相关的危险因素,采用受试者工作曲线(ROC曲线)分析血清TGF-β1、MMP-9和TIMP-1水平在预测子宫内膜息肉切除术后2年内发生宫腔粘连的诊断效能。结果:子宫内膜息肉切除术后2年内发生宫腔粘连与孕次、剖宫产史、刮宫史、内膜增生、盆腔炎史、多发息肉、血清TGF-β1、MMP-9和TIMP-1水平具有相关性(P<0.01),而与年龄、产次、引产史、宫内节育器史、绝经和体质量指数无相关性(P>0.05)。多因素回归分析发现孕次、盆腔炎史、血清TGF-β1和TIMP-1水平是术后2年内发生宫腔粘连的独立危险因素(P<0.05),而血清MMP-9水平是术后发生宫腔粘连的保护因子(P<0.05)。轻度粘连组、中度粘连组和重度粘连组患者术前的血清TGF-β1、MMP-9和TIMP-1水平差异均有统计学意义(P<0.01)。血清TGF-β1、MMP-9和TIMP-1水平在预测术后2年内发生宫腔粘连具有较高的联合诊断效能,联合检测的灵敏度为92.5%,特异度为79.6%,曲线下面积为0.932,均优于单个指标TGF-β1(Z=4.752,P<0.01)、MMP-9(Z=4.061,P<0.01)和TIMP-1(Z=3.709,P<0.01)。结论:孕次、盆腔炎史、血清TGF-β1、MMP-9和TIMP-1水平是子宫内膜息肉切除术后2年内发生宫腔粘连的影响因子,血清TGF-βObjective:To screen out the risk factors of intrauterine adhesion after endometrial polypectomy,and to investigate the diagnostic value of serum transforming growth factor-β1(TGF-β1),matrix metalloproteinase-9(MMP-9)and tissue inhibitor of metalloproteinase-1(TIMP-1)levels in predicting intrauterine adhesion within 2 years after endometrial polypectomy.Methods:341 cases of hysteroscopic surgery for endometrial polyps in our hospital from January 2016 to June 2019 were selected.All the patients were followed up for 2 years after surgery.23 cases were lost to follow-up.53 cases occurred intrauterine adhesion within 2 years after surgery(the intrauterine adhesion group),and 265 casesdidn′t occurre intrauterine adhesion(the intrauterine non adhesion group).The pre-operation serum TGF-β1,MMP-9 and TIMP-1 levels were detected by enzyme-linked immunosorbent assay.The risk factors for intrauterine adhesions after hysteroscopy were screened out by univariate analysis and multivariate Logistics analysis.The diagnostic efficacy of serum TGF-β1,MMP-9 and TIMP-1 levels in predicting intrauterine adhesions within 2 years after endometrial polypectomywere analyzed by receiver operating characteristics(ROC)curve.Results:The occurance of intrauterine adhesion within 2 years after endometrial polypectomy was correlated with pregnancy times,history of cesarean section,curettage,endometrial hyperplasia,pelvic inflammation,multiple polyps,serum TGF-β1,MMP-9 and TIMP-1 levels(P<0.01),but was not correlated with age,times of labor,history of induced labor,history of IUD,menopause and body mass index(P>0.05).Multivariate analysis showed that pregnancy times,history of pelvic inflammatory,serum TGF-β1 and TIMP-1 levels were independent risk factors for intrauterine adhesion within 2 years after endometrial polypectomy(P<0.05),while the serum MMP-9 level was a protective factor for postoperative intrauterine adhesion(P<0.05).The preoperative levels of serum TGF-β1,MMP-9 and TIMP-1 in mild adhesion group,moderate adhesion group an

关 键 词：子宫内膜息肉 宫腔粘连 转化生长因子β1 基质金属蛋白酶-9 金属蛋白酶抑制因子-1 

分 类 号：R711.52[医药卫生—妇产科学] R619.045[医药卫生—临床医学] R713.41