中重度宫腔粘连患者术后应用生长激素的疗效及子宫内膜生长激素受体和雌激素α受体的表达  

The Efficacy of GH and the Expression of GHR and ER-α in Patients with Intrauterine Adhesions

作　　者：李颖颖 张林东[1] 张钦山 王媛媛 王智霆 封全灵[1] LI Yingying;ZHANG Lindong;ZHANG Qinshan(Department of Obstetrics and Gynecology,The Third Affiliated Hospital of Zhengzhou University,Zhengzhou Henan 450052,China)

机构地区：[1]郑州大学第三附属医院妇产科,河南郑州450052 [2]青岛市胶州中心医院妇科,山东青岛266042

出　　处：《实用妇产科杂志》2023年第10期775-779,共5页Journal of Practical Obstetrics and Gynecology

基　　金：河南省医学科技攻关计划(编号:LHGJ20190370)。

摘　　要：目的:探讨中重度宫腔粘连(IUA)患者行宫腔镜下宫腔粘连分离术(TCRA)后应用生长激素(GH)的疗效,并检测中重度IUA患者与正常者子宫内膜GH受体(GHR)、雌激素α受体(ER-α)的表达差异。方法:选取2021年6月至2022年6月在郑州大学第三附属医院就诊,采用美国生育协会(AFS)评分系统诊断为中重度IUA并行TCRA术成功分离,术后有生育要求并愿意随访的患者67例。根据术后是否使用GH,将研究对象分为对照组(n=35)和GH组(n=32)。术后2个月观察两组患者内膜恢复情况、AFS评分变化情况、月经改善情况、宫腔形态恢复情况、再粘连率、术后6个月妊娠率。随机选择67例患者中18例作为粘连内膜组,另外选择本院同期非IUA患者18例作为正常内膜组,比较两组患者子宫内膜中GHR、ER-α的表达差异。结果:①治疗后与对照组比较,GH组子宫内膜厚度更大(6.55±0.77 mm vs.5.46±0.46 mm),手术前后子宫内膜差值较大(2.77±0.81 mm vs.1.76±0.75 mm),AFS评分更低(1.34±0.31分vs.2.43±0.44分),AFS评分差值更大(6.69±2.15分vs.5.46±2.63分),月经改善有效率更高(87.50%vs.77.14%),宫腔形态恢复有效率更高(90.63%vs.85.71%),差异均有统计学意义(P<0.05);再粘连率和妊娠率差异无统计学意义(P>0.05)。对照组和GH组各自治疗前后子宫内膜厚度、AFS评分比较,差异均有统计学意义(P<0.05)。②与正常内膜组比较,粘连内膜组子宫内膜GHR表达更低(0.0125±0.0060 vs.0.0248±0.0072)、ER-α更高(0.1342±0.0680 vs.0.0588±0.0248),差异均有统计学意义(P<0.05)。结论:GH应用于中重度IUA患者TCRA术后有积极作用,中重度IUA子宫内膜与正常子宫内膜中GHR、ER-α的表达水平有差异,为IUA术后治疗提供一定理论依据。Objective:To investigate the efficacy of growth hormone in patients with moderate to severe intrauterine adhesion(IUA)after hysteroscopic separation of intrauterine adhesions(TCRA),and to detect the differences in the expression of growth hormone receptor(GHR)and estrogen-αreceptor(ER-α)in endometrium between patients with moderate to severe IUA and normal subjects.Methods:From June 2021 to June 2022,67 patients with moderate and severe IUA after TCRA were selected from the Third Affiliated Hospital of Zhengzhou University,who were diagnosed by the American Fertility Association(AFS)scoring system and were willing to follow up after having fertility requirements.According to whether growth hormone was used after surgery,the study subjects were divided into the control group(n=35)and the GH group(n=32).The endometrial recovery,AFS score changes,menstrual improvement,uterine cavity morphology recovery,readhesion rate,and pregnancy rate at 6 months after surgery were observed in both groups of patients at 2 months after surgery.Randomly select 18 out of 67 patients as the adhesive endometrium group,and select 18 non-IUA patients in the same period of our hospital as the normal endometrium group.The differences in GHR and ER-αexpression in endometrial between the two groups were compared.Results:①Compared with the control group,the GH group showed an increase in endometrial thickness(6.55±0.77 mm vs.5.46±0.46 mm),with a larger endometrial difference(2.77±0.81 mm vs.1.76±0.75 mm),a decrease in the AFS score(1.34±0.31 score vs.2.43±0.44 score),a larger difference of AFS score(6.69±2.15 score vs.5.46±2.63 score),and a higher effective rate of menses improvement(87.50%vs.77.14%),and a greater effective rate of uterine shape recovery(90.63%vs.85.71%)after treatment,the differences were statistically significant(P<0.05).There was no significant difference between readhesion rate and pregnancy rate(P>0.05).Comparison of endometrial thickness and AFS score before and after treatment between the control group and

关 键 词：宫腔粘连 生长激素 宫腔冲洗 生长激素受体 雌激素Α受体 

分 类 号：R713.4[医药卫生—妇产科学]