王剑 曹敏

〔摘要〕 目的 观察定坤丹对宫腔粘连患者宫腔镜术后再粘连预防的疗效及相关细胞因子的影响。方法 将120例宫腔粘连患者宫腔镜术后随机分为中药组、西药组、空白组各40例，西药组术后予常规西药口服，中药组术后予定坤丹口服，疗程均为3个月；空白组术后无特殊药物治疗。观察治疗前后3组患者宫腔粘连程度及子宫内膜组织转化生长因子-β1 （TGF-β1）及纤溶酶原激活剂抑制因子（PAI-1）的变化。结果 （1）中药组治疗后总有效率显著高于空白组（P<0.05）；中药组与西药组治疗后总有效率比较差异无统计学意义（P>0.05）；（2）治療前3组子宫内膜组织TGF-β1 及PAI-1的表达比较差异无统计学意义（P>0.05）；治疗后中药组和西药组子宫内膜组织TGF-β1 及PAI-1的表达均明显低于空白组（P<0.05），中药组和西药组比较差异无统计学意义（P>0.05）。结论 定坤丹对宫腔粘连患者宫腔镜术后再粘连预防有一定疗效，其作用机制可能与抑制子宫内膜组织TGF-β1、 PAI-1的表达相关。

〔关键词〕 宫腔粘连复发；宫腔粘连分离术；定坤丹；转化生长因子-β1；纤溶酶原激活剂抑制因子

〔中图分类号〕R271.1；R711.3 〔文献标志码〕B 〔文章编号〕doi：10.3969/j.issn.1674-070X.2018.08.017

〔Abstract〕 Objective To investigate the effect of Dingkundan in the prevention of recurrence after hysteroscopic surgery in patients with intrauterine adhesions and its influence on related cytokines. Methods A total of 120 patients with intrauterine adhesions were equally and randomly divided into three groups after hysteroscopic surgery： traditional Chinese medicine （TCM） group， Western medicine group， and blank group. After surgery， the Western medicine group was given oral administration of conventional Western medicine， while the TCM group was given oral administration of Dingkundan. The course of the treatment was 3 months in both groups. However， the blank group was not given any medicine after surgery. The degree of intrauterine adhesions and the expression of transforming growth factor-β1 （TGF-β1） and plasminogen activator inhibitor （PAI-1） in the endometrium were observed before and after treatment. Results After treatment， the TCM group had a significantly higher overall response rate than the blank group （P<0.05）. However， there was no significant difference in the overall response rate between the TCM group and the Western medicine group （P>0.05）. There was no significant difference in the expression of TGF-β1 and PAI-1 in the endometrium between the three groups before treatment （P>0.05）. After treatment， the expression of TGF-β1 and PAI-1 in the endometrium in the TCM group and the Western medicine group was significantly lower than that in the blank group （P<0.05）. However， there was no significant difference in the expression of TGF-β1 and PAI-1 in the endometrium between the TCM group and the Western medicine group （P>0.05）. Conclusion Dingkundan has a certain effect in preventing the recurrence after hysteroscopic surgery in patients with intrauterine adhesions. The mechanism may be related to the inhibition of TGF-β1 and PAI-1 expression in the endometrium.

〔Keywords〕 recurrence of intrauterine adhesions； transcervical resection of adhesion； Dingkundan； TGF-β1； PAI-1

宫腔粘连是指因各种原因造成的宫腔前后壁粘连、变形甚至宫腔闭锁。近年来，随着宫腔粘连的发病率和检出率的上升，其对女性的身心健康和生育能力造成了严重的影响。目前对宫腔粘连形成的分子机制的研究越来越多，经学者研究发现转化生长因子-β1 （TGF-β1）及纤溶酶原激活剂抑制因子（PAI-1）可能在宫腔粘连纤维化的形成中起到了一定的作用。虽然宫腔镜下宫腔粘连分离术（TCRA）是治疗宫腔粘连的最佳方法和标准术式，但是TCRA术后子宫内膜的修复需要一定的时间，并且由于基底层的暴露、出血等原因二次粘连仍有可能发生，再粘连的发生率为3.1%～23.5%，故如何采取有效的方法预防宫腔粘连的复发成为一个新的问题。本研……