罗氏内异方联合腹腔镜手术对轻型子宫内膜异位症不孕患者血清MMP 9 TIMP 1的影响

【摘要】 目的:探讨基质金属蛋白酶-9(MMP-9)/金属蛋白酶抑制因子-1(TIMP-1)在内异症发病机制中作用;观察中药罗氏内异方联合腹腔镜手术对轻型子宫内膜异位症不孕患者血清MMP-9、TIMP-1及MMP-9/TIMP-1的影响,籍以从免疫学角度探讨其治疗轻型子宫内膜异位性不孕的疗效机理,并指导临床治疗。方法:研究对象必须同时符合轻型子宫内膜异位症和不孕的诊断标准。将收集符合入组标准的轻型子宫内膜异位性不孕症39例患者分为两组,手术+中药组:腹腔镜术后联合口服罗氏内异方20例;单纯手术组:腹腔镜术后未追加药物治疗19例。同时对入组的病人都行B超监测排卵,在排卵前后指导同房。采用酶联免疫法测定治疗前后两组患者血清中MMP-9、TIMP-1的水平,计算MMP-9/TIMP-1值,及统计两组治疗后3个月后两组患者症状改善情况,并随访6个月后的受孕人数及受孕率、流产率。结果:(1)除腰骶不适外,痛经、肛门坠胀、性交痛、下腹痛等症状在手术+中药组治疗后较单纯手术组治疗后明显改善,有显著性差异(P＜0.05)。(2)手术+中药组患者中,受孕者共14例,受孕率70.0%(14/20),其中4例在术后3...更多个月内怀孕,均未发生流产;其余10例在术后3—6个月怀孕,其中一例在孕5月自然流产,流产率7.1%(1/14)。单纯腹腔镜组患者中,受孕者6例,受孕率31.6%,其中1例在术后3个月内怀孕,均未发生流产;其余5例在术后3—6个月怀孕,其中2例患者孕1月余流产,流产率33.3%(2/6)。两组患者术后受孕率对比,有显著性差异(P＜0.05);两者流产率对比,无显著性差异(P＞0.05)。(3)血清MMP-9、MMP-9/TIMP-1的水平在两组治疗后均较治疗前明显降低,有显著性差异(P＜0.05),在手术+中药组治疗后较单纯手术组治疗后明显降低(P＜0.05);血清TIMP-1的水平在两组治疗后较治疗前明显升高(P＜0.05),在手术+中药组治疗后较单纯手术组治疗后明显升高,有显著性差异(P＜0.05)。结论:1.罗氏内异方联合腹腔镜手术是治疗轻型子宫内膜异位症不孕的有效方法,其能明显改善患者的主要临床症状,并提高受孕率。2.罗氏内异方联合腹腔镜手术治疗轻型子宫内膜异位症不孕的疗效机理可能与降低MMP-9、提高TIMP-1的表达,平衡MMP-9/TIMP-1的水平,抑制子宫内膜的侵袭、种植有关。  还原

【Abstract】 Objective To investigate the mechanism of matrix metalloproteinase 9(MMP-9) and tissue inhibitor of metalloproteinase(TIMP-1) on Endometriosis.To obsert the effects on which luoshineiyifang combined Laparoscopic treatment makes on serum MMP-9 /TIMP-1 level of mild Endometriosisassociated fertilization.To investingate the mechanism of their action on patients of mild Endometriosis associated fertilization from immunologist,and explore a reasonable treatment for such patients.Methods Research subjects must be consistent with the mild endometriosis associated infertility diagnostic criteria.39 cases accorded with the diagnosis standards of mild Endometriosis and Infertillity,simultaneously were randomly divided into Chinese herbal medicine combined laparoscopic surgery group(n=20),simple laparoscopic surgery group(n=19),no extra medicine after laparoscopic surgery.Observe the ovulation of the follicle by

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