宫腔粘连患者TCRA术后不同剂量雌激素对子宫内膜血流的影响  

Effect of Different Doses of Estrogen on Endometrial Blood Flow after TCRA in Patients with IUA

作　　者：杨洁 徐大宝[3] 金毅然[4] 罗桑 杨澈 邹晓洁 刘丹[2,4,5] YANG Jie;XU Dabao;JIN Yiran(First College of Clinical Medicine,Ningxia Medical University,Yinchuan Ningxia 750004,China;Department of Obstetrics and Gynecology,The Third Xiangya Hospital,Central South University,Changsha Hunan 410013,China;Medical Science Research Institute,General Hospital of Ningxia Medical University,Yinchuan Ningxia 750004,China)

机构地区：[1]宁夏医科大学第一临床医学院,宁夏银川750004 [2]宁夏医科大学教育部生育力保持重点实验室,宁夏银川750004 [3]中南大学湘雅三医院妇产科,湖南长沙410013 [4]宁夏医科大学总医院医学科学研究院,宁夏银川750004 [5]宁夏医科大学总医院妇科,宁夏银川750004

出　　处：《实用妇产科杂志》2025年第2期130-135,共6页Journal of Practical Obstetrics and Gynecology

基　　金：国家自然科学基金项目(编号:82260300);中央引导地方科技发展专项(编号:2022FRD05039)。

摘　　要：目的:分析宫腔粘连(IUA)患者宫腔镜下宫腔粘连分离术(TCRA)后不同剂量雌激素对子宫内膜血流的影响。方法:将2021~2023年在宁夏医科大学总医院行TCRA的中、重度两组IUA患者共70例根据术后不同雌激素用量,组内再分为A组(4 mg/d)和B组(6 mg/d)。2月后复查宫腔镜,3月后随访月经量、B超检测分泌期子宫内膜厚度及血流参数,免疫荧光法检测增殖、纤维化及血流相关因子。结果:①重度IUA组内,A_(2)组与B_(2)组在宫腔再粘连率无差异,B_(2)组子宫内膜上皮化满意率及子宫内膜腺管密度满意率优于A_(2)组,差异有统计学意义(P<0.05)。中度IUA组内3项指标差异均无统计学意义(P>0.05)。②术后3月:重度IUA组内,两组在月经量、子宫内膜厚度(ET)、子宫内膜容积(EV)、子宫内膜血流值(血管指数、血流指数、血管化血流指标)、子宫动脉血流值(子宫动脉搏动指数、子宫动脉阻力指数)差异均有统计学意义(P<0.05);上述指标在中度IUA组内差异均无统计学意义(P>0.05)。③子宫内膜标志物检测:重度IUA组内B_(2)组的增殖标志物(Ki-67)及血管生成标志物(CD31、CD34、CD146、b-FGF、VEGF)表达较A_(2)组高,而纤维化标志物(α-SMA、TGF-β1)表达较A_(2)组低,差异有统计学意义(P<0.05);中度IUA组内A_(1)组和B_(1)两组上述指标表达水平的比较差异均无统计学意义(P>0.05)。结论:TCRA术后短期应用相对大剂量雌激素(6 mg/d)可以通过对重度IUA患者子宫内膜血流的改善促进子宫内膜更好地修复,而对中度IUA子宫内膜修复影响没有差异性。Objective:To analyze the effect of different doses of estrogen on endometrial blood flow after transcervical resection of adhesion(TCRA)surgery in patients with intrauterine adhesion(IUA).Methods:A total of 70 moderate and severe IUA patients who underwent TCRA in the General Hospital of Ningxia Medical University from 2021 to 2023 were divided into group A(4 mg/day)and group B(6 mg/day)according to the dosage of estrogen after operation.Reexamination of hysteroscopy was performed 2 months later,menstrual volume was followed up,uterine parameters in secretory phase were detected by B-ultrasound,and factors related to proliferation,fibrosis and blood flow were detected by immunofluorescence after 3 months.Results:①In the severe IUA group,there was no difference in the rate of intrauterine re adhesion between group A_(2)and group B_(2).The satisfaction rate of endometrial epithelialization and endometrial glandular duct density in group B_(2)was higher than that in group A_(2),and the difference was statistically significant(P<0.05).There was no significant difference in the three indicators within the moderate IUA group(P>0.05).②Three months after operation,in the severe IUA group,there were statistically significant differences(P<0.05)in menstrual flow,endometrial thickness ET,endometrial volume EV,endometrial blood flow values(VI,FI,VFI),and uterine artery blood flow values(PI,RI)between the two groups;The above indicators showed no statistically significant differences within the moderate IUA group(P>0.05).③Detection of endometrial markers:the expression of proliferation marker(Ki-67)and angiogenesis marker(CD31,CD34,CD146,b-FGF,VEGF)in group B_(2)was higher than that in group A_(2),while the expression of fibrosis marker(α-SMA,TGF-β1)was lower,with statistical significance(P<0.05).There was no significant difference in the expression of above indexes between group A_(1)and group B_(1)in moderate IUA group(P>0.05).Conclusions:Short-term application of relatively high dose estrogen(6 mg/day)after TCRA ca

关 键 词：宫腔粘连 经宫腔镜宫腔粘连分离术 雌激素 子宫内膜血流 

分 类 号：R713.4[医药卫生—妇产科学]