宫腔黏连分离术后创面渗出液中TGF-β1、α-SMA表达与术后复发相关性探究  

Exploration of the correlation between the expression of TGF-β1 andα-SMA in the wound exudate after intrauterine adhesions separation surgery and postoperative recurrence

作　　者：刘艳秋 代会波 贾玉俭 LIU Yan-qiu;DAI Hui-bo;JIA Yu-jian(Department of Gynecology,the First People′s Hospital of Shuangliu District,Chengdu/West China Airport Hospital,Sichuan University,Chengdu 610200,China;Department of Gynecology,Chengdu Women and Children′s Central Hospital,Sichuan Province,Chengdu 610000,China)

机构地区：[1]四川省成都市双流区第一人民医院,四川大学华西空港医院妇科,四川成都610200 [2]四川省成都市妇女儿童中心医院妇科,四川成都610000

出　　处：《河北医科大学学报》2023年第10期1162-1167,共6页Journal of Hebei Medical University

基　　金：成都市医学科研课题立项(2018078)。

摘　　要：目的探讨宫腔镜下宫腔黏连分离术后创面渗出液中转化生长因子β1(transforming growth factor-β1,TGF-β1)、α平滑肌肌动蛋白(ɑ-smooth muscle actin,α-SMA)表达与术后复发的相关性。方法选取行宫腔镜下宫腔黏连分离术的育龄女性患者98例进行前瞻性队列研究,根据术后复发情况分为复发组33例、未复发组65例,比较2组一般资料、术后3 h、术后9 h、术后24 h创面渗出液中TGF-β1、α-SMA水平,采用Spearman法分析术后3 h、术后9 h、术后24 h创面渗出液中TGF-β1、α-SMA水平与复发的关系,采用Logistic回归分析宫腔黏连分离术后复发的相关影响因素,采用交互作用系数γ和OR值分析创面渗出液中TGF-β1、α-SMA表达对术后复发影响的交互作用,采用R语言绘制宫腔黏连分离术后复发的列线图预测模型,采用受试者工作特征曲线(receiver operating characteristic,ROC)评价列线图模型的预测效能,采用决策曲线分析法(decision curve analysis,DCA)评价列线图模型的临床效用。结果复发组重度宫腔黏连、人工流产或刮宫史≥2次、有其他子宫手术史患者多于未复发组(P<0.05)。随时间延长,2组创面渗出液中TGF-β1、α-SMA表达水平均呈升高再降低趋势,术后9 h达峰值,复发组创面渗出液中TGF-β1、α-SMA表达水平高于未复发组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。Spearman分析结果显示,术后3 h、术后9 h、术后24 h创面渗出液中TGF-β1、α-SMA表达均与术后复发呈正相关(r=0.742、0.922、0.867;0.659、0.880、0.823,P<0.001)。Logistic回归分析结果显示,重度宫腔黏连程度、人工流产或刮宫史≥2次、其他子宫手术史、术后9 h创面渗出液中TGF-β1和α-SMA均是宫腔黏连分离术后复发的危险因素(P<0.05)。交互作用分析显示,TGF-β1和α-SMA为超相乘模型,α-SMA对TGF-β1的效应具有正向交互作用(P<0.05)。绘制宫腔黏连分离术后复发的Objective To explore the correlation between the expression of transforming growth factor-β1(TGF-β1),ɑ-smooth muscle actin(α-SMA)in wound exudate and postoperative recurrence after hysteroscopic separation of intrauterine adhesions.Methods A prospective cohort study was conducted on 98 female patients of reproductive age who underwent hysteroscopic separation of uterine adhesions,and they were divided into recurrence(n=33)and non-recurrence(n=65)groups according to postoperative recurrence.The general data,TGF-β1 andα-SMA levels in wound exudate at 3 h,9 h and 24 h after surgery were compared between the two groups.The Spearman method was used to analyze the relationship between the levels of TGF-β1 andα-SMA in wound exudate and recurrence at 3 h,9 h,and 24 h after surgery,and logistic regression analysis was used to analyze the relevant influencing factors of recurrence after uterine adhesions separation surgery.The interaction coefficientsγand OR values were used to analyze the interaction of TGF-β1 andα-SMA expression in wound exudate on postoperative recurrence,and R language was used to plot the nomogram prediction model for recurrence after uterine adhesion separation.The predictive efficacy of the nomogram model was evaluated using the receiver operating characteristic(ROC)curve,and the clinical utility of the nomogram model was evaluated using decision curve analysis(DCA).Results There were more patients with severe uterine adhesions,history of induced abortion or curettage≥2 times,and a history of other uterine surgery in the recurrence group than in the non-recurrence group(P<0.05).With the extension of time,the expression levels of TGF-β1 andα-SMA in the wound exudate of both groups showed an increasing and then decreasing trend,reaching a peak at 9 h after surgery;the expression levels of TGF-β1 andα-SMA in the wound exudate of the recurrence group were higher than those of the non-recurrence group,and there was a statistically significant difference in the interaction between groups,

关 键 词：育龄女性 宫腔镜下宫腔黏连分离术 转化生长因子Β1 Α-SMA 

分 类 号：R713.4[医药卫生—妇产科学]