自体富血小板血浆灌注对宫腔粘连手术后患者宫腔引流液细胞因子水平的影响  

Effect of autologous platelet-rich plasma perfusion on cytokines in uterine drainage fluid of patients with intrauterine adhesions following hysteroscopic adhesiolysis

作　　者：沈明虹 郭银树[1] 段华[1] Shen Minghong;Guo Yinshu;Duan Hua(Gynecological Minimally Invasive Center,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100006,China;the Department of Gynecology,Fujian Medical University Provincial Clinical Medical College,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]首都医科大学附属北京妇产医院,北京妇幼保健院妇科微创中心,北京100006 [2]福建医科大学省立临床医学院福建省立医院妇科,福州350001

出　　处：《中华妇产科杂志》2024年第6期440-446,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：国家重点研发计划(2018YFC1004803)。

摘　　要：目的:探讨中~重度宫腔粘连(IUA)患者行宫腔镜宫腔粘连分离术后,自体富血小板血浆(PRP)灌注后宫腔引流液中细胞因子水平的变化及其特点。方法:选择2020年11月至2021年3月在首都医科大学附属北京妇产医院妇科微创中心接受宫腔镜宫腔粘连分离术的中~重度IUA患者30例,随机数字表法分为:PRP组15例(分离术毕放置宫腔适形球囊+PRP宫腔灌注),对照组15例(仅放置宫腔适形球囊)。术后48 h开放宫腔适形球囊引流通道开关,分不同时间点收集宫腔引流液(术后24 h经引流通道开关近端以注射器抽取并采集引流液,术后48、72、96、120 h直接经引流通道收集引流液),分析各时间点宫腔引流液中血小板源性生长因子BB(PDGF-BB)、血管内皮生长因子A(VEGF-A)、胰岛素样生长因子1(IGF-1)、转化生长因子β1(TGF-β1)的水平及其水平变化特征。结果:(1)宫腔引流量:PRP组与对照组患者术后120 h总引流量分别为(21.8±2.9)、(22.7±2.7)ml,两组比较,差异无统计学意义(t=-0.847,P>0.05)。术后72、96、120 h两组引流量分别比较,差异均无统计学意义(P均>0.05)。(2)宫腔引流液中细胞因子水平的变化:①PDGF-BB:术后24、48 h PRP组患者PDGF-BB水平的中位数分别为6.6和9.6μg/L,对照组分别为4.7、2.7μg/L,PRP组均明显高于对照组(P均<0.05);术后72、96、120 h两组PDGF-BB水平变化无显著差异(P均>0.05)。②VEGF-A:术后24、48 h PRP组VEGF-A水平的中位数分别为3.5、2.8μg/L,对照组分别为1.6、1.2μg/L,PRP组均高于对照组(P均<0.05);术后72、96、120 h两组VEGF-A水平无显著差异(P均>0.05)。③IGF-1:术后48 h PRP组IGF-1水平的中位数为39.5μg/L,对照组为8.6μg/L,PRP组高于对照组(P<0.05);术后24、72、96、120 h IGF-1水平分别比较,差异均无统计学意义(P均>0.05)。④TGF-β1:两组术后24、48、72、96及120 h水平变化均无显著差异(P均>0.05)。结论:IUA患者子宫腔整复手术后PRP灌注,能够提�Objective To investigate the effect of autologous platelet-rich plasma(PRP)perfusion on the levels of cytokines in uterine drainage fluid in patients with moderate to severe intrauterine adhesions(IUA)following hysteroscopic adhesiolysis.Methods Thirty patients with moderate to severe IUA who underwent hysteroscopic adhesiolysis at Beijing Obstetrics and Gynecology Hospital,Capital Medical University from November 2020 to March 2021 were randomly divided into two groups:the PRP group(15 patients with placement of intrauterine-suitable balloons and PRP infusion)and the control group(15 patients with placement of intrauterine-suitable balloons only).For all patients,the channel switch was opened 48 hours after the surgery.The drainage fluid of the uterine cavity was collected using syringes through the proximal end of the drainage channel switch at 24 hours after the surgery and through the drainage channel directly at 48,72,96,and 120 hours after the surgery,and the levels of related cytokines including platelet-derived growth factor BB(PDGF-BB),vascular endothelial growth factor A(VEGF-A),insulin-like growth factor 1(IGF-1)and transforming growth factor-β1(TGF-β1)in the drainage fluid of the uterine cavity were evaluated,respectively.Results(1)The changes in volumes of uterine cavity drainage fluid:the total drainage fluid volumes of the PRP group and the control group in 120 hours after the surgery were(21.8±2.9)and(22.7±2.7)ml,respectively,and there was no statistically significant difference between the two groups(t=-0.847,P>0.05).No significant differences were found in the volumes of drainage fluid between the two groups at 72,96,and 120 hours after the surgery(all P>0.05).(2)Variation in cytokine levels in the uterine cavity drainage fluid:①PDGF-BB:median PDGF-BB levels at 24 and 48 hours after the surgery in the PRP group(6.6 and 9.6μg/L,respectively)were significantly higher than those in the control group(4.7 and 2.7μg/L,respectively;all P<0.05).There were no significant differences in PDGF-BB le

关 键 词：子宫疾病 组织粘连 富血小板血浆 血小板源性生长因子 血管内皮生长因子A 胰岛素样生长因子 

分 类 号：R713.4[医药卫生—妇产科学]