CAJ | 학술논문

目的：探讨人工周期对宫腔粘连患者粘连分解术预后的影响及机制。方法80例宫腔粘连患者随机分为观察组和对照组。观察组行宫腔镜宫腔粘连分解术（TCRA），术后人工周期连续治疗3个月：每日服用戊酸雌二醇（每次9 mg ，每天1次）21d，后7d加服醋酸甲羟孕酮（每次10mg，每天1次），停药7d为1个周期；对照组直接施行TCRA，3个月后复查。采用酶联免疫法测定血清6项性激素，包括卵泡刺激素（FS H ）、黄体生成素（L H ）、雌激素（E2）、催乳素（PRL ）、孕酮（P ）及睾酮（T ）。实时定量PCR和蛋白质印迹法检测子宫内膜中基质金属蛋白酶-9（MMP-9）和转化生长因子-β1（TGF-β1）的表达。结果与对照组相比较，人工周期治疗结合手术治疗显著提高了轻中度宫腔粘连患者TCRA术的治疗有效率（P＜0．05）；对照组和观察组患者血清中FSH、LH、E2、PRL、P和T等性激素水平差异无统计学意义（均 P＞0．05）；人工周期治疗显著性改善了 TCRA术后宫腔粘连程度，增加MMP-9的表达并降低TGF-β1的表达。结论人工周期改善了宫腔粘连患者TCRA术的预后效果，其机制可能与人工周期增加MMP-9的表达和降低TGF-β1的表达有关。
목적：탐토인공주기대궁강점련환자점련분해술예후적영향급궤제。방법80례궁강점련환자수궤분위관찰조화대조조。관찰조행궁강경궁강점련분해술（TCRA），술후인공주기련속치료3개월：매일복용무산자이순（매차9 mg ，매천1차）21d，후7d가복작산갑간잉동（매차10mg，매천1차），정약7d위1개주기；대조조직접시행TCRA，3개월후복사。채용매련면역법측정혈청6항성격소，포괄란포자격소（FS H ）、황체생성소（L H ）、자격소（E2）、최유소（PRL ）、잉동（P ）급고동（T ）。실시정량PCR화단백질인적법검측자궁내막중기질금속단백매-9（MMP-9）화전화생장인자-β1（TGF-β1）적표체。결과여대조조상비교，인공주기치료결합수술치료현저제고료경중도궁강점련환자TCRA술적치료유효솔（P＜0．05）；대조조화관찰조환자혈청중FSH、LH、E2、PRL、P화T등성격소수평차이무통계학의의（균 P＞0．05）；인공주기치료현저성개선료 TCRA술후궁강점련정도，증가MMP-9적표체병강저TGF-β1적표체。결론인공주기개선료궁강점련환자TCRA술적예후효과，기궤제가능여인공주기증가MMP-9적표체화강저TGF-β1적표체유관。
Objective To investigate the effect of the artificial cycle on the prognosis after transcervical resection of adhesion (TCRA) and its mechanism .Methods 80 patients with intrauterine adhesion were randomly divided into the observation group and the control group .The observation group were performed TRCA and postoperative artificial cycle for successive 3 months :oral es-tradiol valerate(9 mg once daily) for 21 d ,adding oral medroxyprofgesterone acetate(10 mg once dialy) on 15 d ,then the medication discontinuation for 7 d ,which was taken as 1 cycle;the control group received only TCRA .The re-examination was performed after 3 months .The levels of follicle stimulating hormone(FSH) ,luteinizing hormone(LH) ,estradiol(E2 ) ,prolactin(PRL) ,progesterone (P) and testosterone(T) were examined by ELISA after TCRA three months .The expression of MMP-9 and TGF-β1 in adhesive endometrium were detected by real-time PCR and Western blot .Results Compared with the control group ,the artificial cycle thera-py combined with the operation could significantly increase the effective rate of TCRA for treating mild and moderate intrauterine adhesion(P<0 .05);the seum levels of FSH ,LH ,E2 ,PRL ,P and T had no statistical differences between the observation group and the control group(P>0 .05);the artificial cycle significantly improved the adhesive degree of intrauterine adhesion ,increased the MMP-9 expression and decreased the TGF-β1 expression .Conclusion Artificial cycle could improve the degree of uterine cavity ad-hesion after TCRA ,which the mechanism might be related to the increase of MMP-9 expression and decrease of TGF-β1 expres-sion .