盆腔子宫内膜异位症与输卵管性不孕的关系及术后GnRH-a的应用效果研究  

Relationship between pelvic endometriosis and tubal infertility and the effectiveness of postoperative GnRH-a therapy

作　　者：栗浩然 宋少华 华晴 李红娟 LI Hao-ran;SONG Shao-hua;HUA Qing;LI Hong-juan(Department of Obstetrics and Gynecology,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450001,Henan,CHINA;Department of Nutrition,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450001,Henan,CHINA)

机构地区：[1]郑州大学附属郑州中心医院妇产科,河南郑州450001 [2]郑州大学附属郑州中心医院营养科,河南郑州450001

出　　处：《海南医学》2024年第24期3543-3547,共5页Hainan Medical Journal

基　　金：河南省医学科技攻关计划项目(编号:LHGJ2021076)。

摘　　要：目的分析盆腔子宫内膜异位症(EMS)与输卵管性不孕的关系,并观察术后应用促性腺激素释放激素激动剂(GnRH-a)治疗的效果。方法采用前瞻性研究方法选取2021年3月至2022年2月郑州大学附属郑州中心医院收治的369例不孕患者纳入研究,根据不孕原因分为输卵管性不孕组189例和非输卵管性不孕组180例。比较两组患者的一般资料、血清糖类抗原125(CA125)、前列腺素E2(PGE2)、表皮生长因子(EGF)、白细胞介素-6(IL-6)和子宫内膜组织P450芳香化酶(P450arom)表达水平以及输卵管微小病变发生率;采用多因素Logistic回归模型分析输卵管不孕的影响因素;将输卵管性不孕患者中的89例EMS患者根据治疗方法的不同分为治疗组(术后行GnRH-a治疗)40例和对照组(术后未行GnRH-a治疗)49例,比较两组患者术前及术后3个月、6个月的血清性激素促卵泡生长激素(FSH)、黄体生成激素(LH)、雌二醇(E2)水平和术后12个月的自然妊娠率。结果输卵管性不孕组患者的EMS构成比为47.09%,明显高于非输卵管性组的22.22%,差异有统计学意义(P<0.05);输卵管性不孕组患者的血清CA125、PGE2、EGF、IL-6、P450arom阳性表达率、输卵管伞端病变率、输卵管憩室率、输卵管系膜囊肿率、输卵管包茎率均明显高于非输卵管性不孕组,差异均有统计学意义(P<0.05);Logistic回归模型分析结果显示,PGE2、EGF、P450arom阳性表达、输卵管伞端病变、输卵管憩室均是输卵管性不孕的影响因素(P<0.05);术前两组患者FSH、LH、E2水平比较差异均无统计学意义(P>0.05);与对照组比较,治疗组患者术后3个月、6个月的FSH、LH、E2水平均降低,差异均有统计学意义(P<0.05);治疗组患者术后12个月的自然妊娠率为60.00%,明显高于对照组的36.73%,差异有统计学意义(P<0.05)。结论输卵管性不孕患者中EMS比例高于非输卵管性患者,PGE2、EGF、P450A arom阳性表达、输卵管伞端病变、输�Objective To analyze the relationship between pelvic endometriosis(EMS)and tubal infertility and to evaluate the efficacy of postoperative gonadotropin-releasing hormone agonist(GnRH-a)therapy.Methods A prospective study enrolled 369 infertile patients treated at Zhengzhou Central Hospital Affiliated to Zhengzhou University from March 2021 to February 2022.Based on infertility causes,the patients were categorized into the tubal infertility group(189 cases)and the non-tubal infertility group(180 cases).General clinical data,serum markers such as cancer antigen 125(CA125),prostaglandin E2(PGE2),epidermal growth factor(EGF),interleukin-6(IL-6),expression of P450 aromatase(P450arom)in endometrial tissue,and the incidence of subtle tubal lesions,were compared between the two groups.A multivariate logistic regression model was used to identify the influencing factors for tubal infertility.Among 89 EMS patients in the tubal infertility group,40 cases were assigned to the treatment group(postoperative GnRH-a therapy),and 49 cases were assigned to the control group(no GnRH-a therapy).The levels of follicle-stimulating hormone(FSH),luteinizing hormone(LH),and estradiol(E2)before and at 3 and 6 months after treatment were evaluated,along with natural pregnancy rates at 12 months postoperatively.Results The proportion of EMS in the tubal infertility group was 47.09%,significantly higher than 22.22%observed in the non-tubal infertility group,with a statistically significant difference(P<0.05).The tubal infertility group exhibited significantly higher levels of serum CA125,PGE2,EGF,IL-6,and positive P450arom expression,as well as higher incidences of fimbrial lesions,tubal diverticula,mesosalpinx cysts,and tubal phimosis,compared to the non-tubal infertility group,with all differences being statistically significant(P<0.05).Logistic regression analysis indicated that PGE2,EGF,positive P450arom expression,fimbrial lesions,and tubal diverticula were influencing factors for tubal infertility(P<0.05).Preoperatively,no significant

关 键 词：子宫内膜异位症 输卵管性不孕 促性腺激素释放激素激动剂 妊娠率 

分 类 号：R711.71[医药卫生—妇产科学]