透明质酸钠凝胶联合芬吗通对高危人工流产术后宫腔粘连的预防作用及对血清IL-10及IL-18水平的影响

目的研究高危人工流产术后宫腔粘连预防中透明质酸钠凝胶和芬吗通的应用效果及对血清白细胞介素-10(IL-10)及白细胞介素-18(IL-18)水平的影响。方法采用回顾性分析方法,研究对象为2018年10月至2019年10月秦皇岛市妇幼保健院收治入院的180例高危人工流产术患者,根据用药方式不同分为对照组和研究组,各90例。对照组单用益母草治疗,研究组在对照组基础上加用透明质酸钠凝胶与芬吗通联合治疗。比较2组治疗前、治疗后3个月血液流变学指标(血浆黏度、全血黏度)、IL-10、IL-18水平与宫腔粘连发生率、粘连程度(轻度、中度、重度)及不良反应发生率。结果治疗前对照组患者血浆黏度、全血黏度、IL-10、IL-18水平为(1.78±0.29)mPa·s、(6.75±2.16)mPa·s、(1008.37±193.19)ng/L、(175.78±29.46)ng/L,研究组分别为(1.81±0.32)mPa·s、(6.63±2.25)mPa·s、(1003.06±196.67)ng/L、(176.32±29.22)ng/L,治疗后3个月对照组患者血浆黏度、全血黏度、IL-10、IL-18水平为(1.49±0.23)mPa·s、(5.67±1.39)mPa·s、(2647.63±521.54)ng/L、(130.09±18.31)ng/L,研究组分别为(1.34±0.14)mPa·s、(3.58±1.21)mPa·s、(3102.54±583.28)ng/L、(113.15±23.63)ng/L。治疗前,2组患者血浆黏度、全血黏度、IL-10、IL-18水平比较,差异无统计学意义(P>0.05)。治疗后3个月,2组患者血浆黏度、全血黏度、IL-18水平低于治疗前,IL-10水平高于治疗前,差异有统计学意义(P<0.05);且治疗后3个月研究组各指标较对照组变化更显著,差异有统计学意义(P<0.05)。治疗3个月后,研究组宫腔粘连发生率(4.44%)及粘连程度(轻度3.33%、中度1.11%、重度0)低于对照组(23.33%、11.11%、7.78%、4.44%),差异有统计学意义(P<0.05)。2组患者不良反应发生率比较,差异无统计学意义(3.33%vs.2.22%,P>0.05)。结论高危人工流产术后宫腔粘连预防中透明质酸钠凝胶和芬吗通的应用效果显著,可有效降低宫腔粘连程度及发生率,还可改善血液流变学及血清白介细胞素水平,且不良反应少。

Effect of sodium hyaluronate gel combined with Fenmotong on the prevention of intrauterine adhesion after high-risk induced abortion and the effect on serum IL-10 and IL-18 levels

Objective To study the effect of sodium hyaluronate gel and fenmotrone in the prevention of intrauterine adhesions after high-risk induced abortion,and their effects on serum interleukin-10(IL-10)and interleukin-18(IL-18)levels.Methods Retrospective analysis was performed on 180 patients admitted to Qinhuangdao Maternal and Child Health Center from October 2018 to October 2019 for high-risk induced abortion.The subjects were divided into control group and study group,90 patients in each group,according to the way of medication.The control group was treated with leonurus heterophylla alone,and the study group was treated with sodium hyaluronate gel combined with fenmotenone on the basis of the control group.Before and after treatment,hemorheological indicators(plasma viscosity,whole blood viscosity),blood-clear mesocytins(IL-10,IL-18)levels,incidence of intrauterine adhesions,degree of adhesions(mild,moderate,severe),and adverse reactions were compared between the two groups.Results Before treatment,the plasma viscosity,whole blood viscosity,IL-10 and IL-18 levels of the control group were(1.78±0.29)mPa·s,(6.75±2.16)mPa·s,(1008.37±193.19)ng/L,(175.78±29.46)ng/L,the study group were(1.81±0.32)mPa·s,(6.63±2.25)mPa·s,(1003.06±196.67)ng/L,(176.32±29.22)ng/L.Three months after treatment,the plasma viscosity,whole blood viscosity,IL-10 and IL-18 levels of the control group were(1.49±0.23)mPa·s,(5.67±1.39)mPa·s,(2647.63±521.54)ng/L,(130.09±18.31)ng/L,the study group were(1.34±0.14)mPa·s,(3.58±1.21)mPa·s,(3102.54±583.28)ng/L,(113.15±23.63)ng/L.There was no difference in plasma viscosity,whole blood viscosity,IL-10 and IL-18 levels between the two groups before treatment(P>0.05).3 months after treatment,plasma viscosity,whole blood viscosity and IL-18 level were lower and IL-10 level were higher than before treatment(P<0.05).And 3 months after treatment,the indicators in the study group changed more significantly than those in the control group,and the differences were statistically significant(P<0.05).After 3 months of treatment,the incidence of intrauterine adhesions(4.44%)and degree of adhesions(mild 3.33%,moderate 1.11%,severe 0)in the study group were lower than those in the control group(23.33%,11.11%,7.78%,4.44%),the differences were statistically significant(P<0.05).There was no difference in adverse reactions between the two groups after treatment(3.33%vs.2.22%,P>0.05).Conclusion The application of sodium hyaluronate gel and Fenmotong in the prevention of intrauterine adhesions after high-risk induced abortion has a significant effect,which can effectively reduce the degree and incidence of intrauterine adhesions,improve the hemorheology and blood cleanness mesocytins,and have fewer adverse reactions.