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陈思忆.基于整合素αvβ3及超声指标探讨厚胞汤加减联合激素疗法预防中重度宫腔粘连患者术后粘连复发的临床研究[J].浙江中西医结合杂志,2020,30(5):
基于整合素αvβ3及超声指标探讨厚胞汤加减联合激素疗法预防中重度宫腔粘连患者术后粘连复发的临床研究
Clinical study on the prevention of postoperative adhesion recurrence in patients with moderate-severe intrauterine adhesions by Houbao decoction combined with hormone therapy based on Integrin αvβ3 and ultrasound parameters
投稿时间:2019-11-21  修订日期:2020-01-12
DOI:
中文关键词:  厚胞汤  激素治疗  宫腔粘连  超声  整合素αvβ3
英文关键词:Houbao decoction  Hormone therapy  Intrauterine adhesion  B-mode ultrasonography  Integrin αvβ3
基金项目:浙江省中医药科技计划项目(2015ZA154)
作者单位E-mail
陈思忆 浙江中医药大学 15757193784@163.com 
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中文摘要:
      目的 通过观察内膜容受性指标整合素αvβ3以及超声指标探讨厚胞汤加减联合激素疗法预防中重度宫腔粘连患者术后粘连再次复发的疗效。方法 将确诊为中重度宫腔粘连患者45例随机均分为激素组、中药组和联合组,每组15人,均行宫腔镜下粘连松解术并放置球囊导尿管。激素组术后采用人工周期疗法,中药组术后以厚胞汤加减口服,联合组则联用两种治疗方法,连续治疗三个周期。观察对比三组治疗前后患者症状,黄体中期超声下子宫内膜厚度、血流分级、容积,及容受性相关因子整合素αvβ3表达改变。结果(1)临床疗效评分:联合组疗效优于激素组,差异具有显著性(P<0.05)。(2)超声指标:三组患者治疗后内膜厚度皆显著增加(P <0.05),但三组间疗效无显著性差异(P >0.05);中药组和联合组治疗后内膜下血流显著增加(P<0.05),但两组间疗效无显著性差异(P>0.05);联合组治疗后内膜容积显著增加(P<0.05)。(3)整合素αvβ3表达水平:三组治疗后表面上皮与腺上皮细胞整合素αvβ3的表达较治疗前显著升高(P<0.05);治疗后联合组表面上皮与腺上皮细胞αvβ3的表达分别较中药组与激素组变化明显,差异有统计学意义(P<0.05);内膜表面上皮细胞、腺上皮细胞、同间质细胞分别比较整合素αvβ3表达水平变化,前两者较后者均有统计学意义(P<0.05)。结论 厚胞汤加减联合激素疗法可有效预防中重度宫腔粘连患者术后粘连复发以及改善月经相关症状,在改善子宫粘连患者内膜容受性方面有一定作用,可增加子宫内膜厚度、基础血运、容积,并提高整合素αvβ3的表达水平。
英文摘要:
      Objective By observing the endometrial receptivity index Integrin αvβ3 and ultrasound parameters, the efficacy of thick cell decoction combined with hormone therapy was investigated to prevent the recurrence of adhesion in patients with moderate and severe intrauterine adhesions. Methods Forty-five patients diagnosed with moderate and severe intrauterine adhesions were randomly divided into hormone group, traditional Chinese medicine group and combination group. Each group of 15 patients received TCRA and placed balloon catheter. After the operation, the hormone group received artificial cycle therapy, the Chinese medicine group received Houbao decoction, and the combined group received two treatment methods, which lasted for three consecutive cycles. Before and after treatment, the symptoms, endometrial thickness, blood flow grade, volume and receptivity related factor Integrin αvβ3 in the middle of corpus luteum in the three groups will be observed and compared. Results (1) Clinical efficacy score: the efficacy of the combined group was better than that of the hormone group, with significant difference (P<0.05).(2) Ultrasonographic indexes: intimal thickness increased significantly after treatment in all three groups (P<0.05), but there was no significant difference between the three groups (P>0.05). Subintimal blood flow increased significantly after treatment in the Chinese medicine group and the combination group (P<0.05), but there was no significant difference between the two groups (P>0.05).The intimal volume of the combined group increased significantly after treatment (P<0.05). (3) Expression of Integrin αvβ3:Integrin αvβ3 expression in surface epithelium and glandular epithelial cells of three groups were significantly increased (P < 0.05); after treatment changes of Integrin αvβ3 expression in the surface epithelium and glandular epithelium of the combination group were obvious respectively, with Chinese medicine group and hormone group, the difference was statistically significant (P < 0.05); in three kinds of cells , Integrin αvβ3 expression in surface epithelial cells and glandular epithelial cells had statistically significance with stromal cells (P < 0.05). Conclusions Houbao decoction combined with hormone therapy can effectively prevent the recurrence of postoperative adhesion in patients with moderate and severe intrauterine adhesions and improve the symptoms, which is also help to improve the endometrial receptivity, such as increasing endometrial thickness, basic blood supply, volume, and improving the expression of Integrin αvβ3.
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