生殖道病原体感染与宫腔粘连术后临床疗效的关系
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摘要
宫腔粘连(intrauterine adhesions,IUA)是当前妇科常见病、多发病,一般继发于人工流产等宫腔操作术后,主要有以下几项临床表现：闭经或经量减少、继发不孕、及妊娠异常等。因IUA导致的子宫内膜性不孕已经成为不孕症的重要原因之一。
目前,宫腔镜下宫腔粘连分离术(transcervical resection of adhesions,TCRA)是治疗宫腔粘连的标准方法,但有研究发现TCRA术后患者仍然会出现不同程度的月经紊乱、妊娠率低及粘连复发,直接影响了TCRA手术的治疗效果。子宫内膜受损伤和(或)感染后,炎症因子及相关细胞因子大量释放使细胞外基质堆积,进一步形成子宫内膜纤维化,最终诱发宫腔粘连,炎症反应可能参与并加重了IUA。
解脲支原体、沙眼衣原体及各种细菌病原体是生殖系统常见的病原体,这些病原体极易上行感染引起子宫内膜炎(endometritis)、盆腔炎等生殖系统炎症。目前文献尚无综合分析解脲支原体、沙眼衣原体及细菌病原体与宫腔粘连分离术后临床疗效相关性的报道。
目的
本研究通过检测宫腔重度粘连患者TCRA术中和术后一个月的解脲支原体、沙眼衣原体及细菌病原体的感染情况,分析TCRA术后给予抗解脲支原体、沙眼衣原体及细菌病原体治疗对术后月经恢复情况、妊娠率以及粘连复发等临床疗效的影响。
方法
选取宫腔镜检查证实为宫腔重度粘连的患者,术前白带常规正常,在TCRA术开始前分别行解脲支原体、沙眼衣原体和宫颈分泌物细菌培养的检查,结果阳性者术后给予抗病原体治疗,术后一月再次复查解脲支原体、沙眼衣原体和宫颈分泌物细菌培养。研究分组依检测项目不同分为解脲支原体组、沙眼衣原体组和宫颈分泌物细菌培养组。解脲支原体组：以术中检测结果为阳性且术后复查仍为阳性的患者为一观察组,术中检测为阳性,术后转为阴性的患者为另一观察组,术中术后检测均为阴性的为对照组；沙眼衣原体组,以术中检测结果为阳性且术后复查仍为阳性的患者为一观察组,术中检测为阳性,术后转为阴性的患者为另一观察组,术中术后检测均为阴性的为对照组；宫颈分泌物细菌培养组,以术中检测结果为阳性且术后复查仍为阳性的患者为一观察组,术中检测为阳性,术后转为阴性的患者为另一观察组,术中术后检测均为阴性的为对照组；比较各观察组与对照组及各观察组之间的月经改善、妊娠率及再复发率等临床疗效的差异。
本研究采使用SPSS13.0软件进行严格的数据分析。所有计量资料使用t检验,各组间的比较使用χ2检验,检验水准α=00.05。
结果
解脲支原体组、沙眼衣原体组及宫颈分泌物细菌培养组三组结果相似,结果均提示TCRA术后给予抗解脲支原体、沙眼衣原体及细菌病原体治疗后检测仍为阳性的观察组患者,其术后的月经改善情况及妊娠率明显差于治疗后转阴的观察组患者及对照组患者,而粘连复发率则显著高于治疗后转阴的观察组及对照组患者。
结论
宫腔粘连分离术后给予有效地抗解脲支原体、沙眼衣原体及细菌病原体的治疗,可显著降低宫腔重度粘连患者再次粘连率,明显改善月经恢复情况和提高妊娠率。
Intrauterine is the frequently-occurring disease, many secondary to uterine cavity operation and postoperative uterine infection, Clinical mainly for amenorrhoea or reduce the quantity, secondary infertility and pregnancy anomaly, etc. In recent years, the incidence of IUA increases year by year trend, is one of the important reasons for lead to infertility, seriously affected the women's physical and mental health.
At present, the dissection of hysteroscopic intrauterine adhesions (transcervical resection of adhesions, TCRA) is a standard method for treatment of intrauterine adhesions, but studies have found that TCRA patients will still appear different degree of menstrual disorders, pregnancy rate was low and the adhesion recurrence, directly affect the operation of the treatment effect of TCRA.Endometrial damage and (or) after infection, inflammatory factor and cytokine release to the extracellular matrix accumulation, further the formation of endometrial fibrosis, eventually induce intrauterine adhesions, inflammatory reaction may participate and aggravation of IUA.
Ureaplasma urealyticum, Chlamydia trachomatis and various bacterial pathogens are pathogens of common reproductive system, these pathogens can easily cause endometritis ascending infection (endometritis), inflammation,reproductive system. At present there is no comprehensive literature analysis clinical relationship between Ureaplasma urealyticum, Chlamydia trachomatis and bacterial pathogens and intrauterine adhesions after reports.
Objective
Through the development of genital tract pathogens and uterine cavity adhesion postoperative recurrence rate again, pregnancy rate and menstrual improvement and clinical curative effect of the correlation study of infection with inflammations and the correlation of uterine cavity adhesion, so as to improve the quality of life of the patients.
Methods
The preoperative and postoperative patients to TCRA respectively line Ureaplsma urealyticum, Chlamydia trachomatis and cervical secretion bacterial culture detection, preoperative and postoperative are all positive in patients to observe group, preoperative and postoperative are negative patients as control group, comparison between group menstruation, pregnancy rate and improve the clinical curative effect and recurrence rate and differences.
Using SPSS13.0software for data analysis. Each group by chi-square test, inspection level a=0.05.
Results
Ureaplasma urealyticum, Chlamydia trachomatis group and the group of cervical secretions bacterial culture results of three groups of similar, antiviral treatment is still positive in the observation group, the postoperative menses and pregnancy rate was significantly difference after treatment negative observation group and patients in the control group, and the observation of adhesion recurrence rate was significantly higher than that of in the observed group and the control group patients.
Conclusion
The treatment effective against Ureaplasma urealyticum, Chlamydia trachomatis and bacterial pathogens to intrauterine adhesions after operation, can significantly reduce the uterine cavity of patients with severe adhesions again the adhesion rate, improve the recovery and improve the pregnancy rate of menstruation, thus improving the prognosis of patients with intrauterine adhesion.
目前,宫腔镜下宫腔粘连分离术(transcervical resection of adhesions,TCRA)是治疗宫腔粘连的标准方法,但有研究发现TCRA术后患者仍然会出现不同程度的月经紊乱、妊娠率低及粘连复发,直接影响了TCRA手术的治疗效果。子宫内膜受损伤和(或)感染后,炎症因子及相关细胞因子大量释放使细胞外基质堆积,进一步形成子宫内膜纤维化,最终诱发宫腔粘连,炎症反应可能参与并加重了IUA。
解脲支原体、沙眼衣原体及各种细菌病原体是生殖系统常见的病原体,这些病原体极易上行感染引起子宫内膜炎(endometritis)、盆腔炎等生殖系统炎症。目前文献尚无综合分析解脲支原体、沙眼衣原体及细菌病原体与宫腔粘连分离术后临床疗效相关性的报道。
目的
本研究通过检测宫腔重度粘连患者TCRA术中和术后一个月的解脲支原体、沙眼衣原体及细菌病原体的感染情况,分析TCRA术后给予抗解脲支原体、沙眼衣原体及细菌病原体治疗对术后月经恢复情况、妊娠率以及粘连复发等临床疗效的影响。
方法
选取宫腔镜检查证实为宫腔重度粘连的患者,术前白带常规正常,在TCRA术开始前分别行解脲支原体、沙眼衣原体和宫颈分泌物细菌培养的检查,结果阳性者术后给予抗病原体治疗,术后一月再次复查解脲支原体、沙眼衣原体和宫颈分泌物细菌培养。研究分组依检测项目不同分为解脲支原体组、沙眼衣原体组和宫颈分泌物细菌培养组。解脲支原体组：以术中检测结果为阳性且术后复查仍为阳性的患者为一观察组,术中检测为阳性,术后转为阴性的患者为另一观察组,术中术后检测均为阴性的为对照组；沙眼衣原体组,以术中检测结果为阳性且术后复查仍为阳性的患者为一观察组,术中检测为阳性,术后转为阴性的患者为另一观察组,术中术后检测均为阴性的为对照组；宫颈分泌物细菌培养组,以术中检测结果为阳性且术后复查仍为阳性的患者为一观察组,术中检测为阳性,术后转为阴性的患者为另一观察组,术中术后检测均为阴性的为对照组；比较各观察组与对照组及各观察组之间的月经改善、妊娠率及再复发率等临床疗效的差异。
本研究采使用SPSS13.0软件进行严格的数据分析。所有计量资料使用t检验,各组间的比较使用χ2检验,检验水准α=00.05。
结果
解脲支原体组、沙眼衣原体组及宫颈分泌物细菌培养组三组结果相似,结果均提示TCRA术后给予抗解脲支原体、沙眼衣原体及细菌病原体治疗后检测仍为阳性的观察组患者,其术后的月经改善情况及妊娠率明显差于治疗后转阴的观察组患者及对照组患者,而粘连复发率则显著高于治疗后转阴的观察组及对照组患者。
结论
宫腔粘连分离术后给予有效地抗解脲支原体、沙眼衣原体及细菌病原体的治疗,可显著降低宫腔重度粘连患者再次粘连率,明显改善月经恢复情况和提高妊娠率。
Intrauterine is the frequently-occurring disease, many secondary to uterine cavity operation and postoperative uterine infection, Clinical mainly for amenorrhoea or reduce the quantity, secondary infertility and pregnancy anomaly, etc. In recent years, the incidence of IUA increases year by year trend, is one of the important reasons for lead to infertility, seriously affected the women's physical and mental health.
At present, the dissection of hysteroscopic intrauterine adhesions (transcervical resection of adhesions, TCRA) is a standard method for treatment of intrauterine adhesions, but studies have found that TCRA patients will still appear different degree of menstrual disorders, pregnancy rate was low and the adhesion recurrence, directly affect the operation of the treatment effect of TCRA.Endometrial damage and (or) after infection, inflammatory factor and cytokine release to the extracellular matrix accumulation, further the formation of endometrial fibrosis, eventually induce intrauterine adhesions, inflammatory reaction may participate and aggravation of IUA.
Ureaplasma urealyticum, Chlamydia trachomatis and various bacterial pathogens are pathogens of common reproductive system, these pathogens can easily cause endometritis ascending infection (endometritis), inflammation,reproductive system. At present there is no comprehensive literature analysis clinical relationship between Ureaplasma urealyticum, Chlamydia trachomatis and bacterial pathogens and intrauterine adhesions after reports.
Objective
Through the development of genital tract pathogens and uterine cavity adhesion postoperative recurrence rate again, pregnancy rate and menstrual improvement and clinical curative effect of the correlation study of infection with inflammations and the correlation of uterine cavity adhesion, so as to improve the quality of life of the patients.
Methods
The preoperative and postoperative patients to TCRA respectively line Ureaplsma urealyticum, Chlamydia trachomatis and cervical secretion bacterial culture detection, preoperative and postoperative are all positive in patients to observe group, preoperative and postoperative are negative patients as control group, comparison between group menstruation, pregnancy rate and improve the clinical curative effect and recurrence rate and differences.
Using SPSS13.0software for data analysis. Each group by chi-square test, inspection level a=0.05.
Results
Ureaplasma urealyticum, Chlamydia trachomatis group and the group of cervical secretions bacterial culture results of three groups of similar, antiviral treatment is still positive in the observation group, the postoperative menses and pregnancy rate was significantly difference after treatment negative observation group and patients in the control group, and the observation of adhesion recurrence rate was significantly higher than that of in the observed group and the control group patients.
Conclusion
The treatment effective against Ureaplasma urealyticum, Chlamydia trachomatis and bacterial pathogens to intrauterine adhesions after operation, can significantly reduce the uterine cavity of patients with severe adhesions again the adhesion rate, improve the recovery and improve the pregnancy rate of menstruation, thus improving the prognosis of patients with intrauterine adhesion.
引文
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[10]Kodaman PH, Arici. Intrauterine adhesions and feitility outcome:how to optimize success? [J].Curr Opin Obstet Gynecol,2007,19(3):207-214
[11]陈慧玲.人工流产术后宫腔粘连的临床分析[J].西部医学,2010,22(8)：1454
[12]康美花,田春芳.宫腔粘连的临床研究进展[J].医学综述,2011,17(9)：1350-1353
[13]Netter AP, Musset R,lanbert A,et al. Traumatic uterine synechiae:a common cause of menstrual insufficiency,sterility,and abortion[J].Am J Obstet Gynecol,1956,71(2):368-375
[14]Polishuk WZ.Endometrial regeneration and adhesion formation[J].S Afr Med J,1975, 49(12):440-442
[15]Leask A,Potential therapeutic targets for cardiac fibrosis:angiotensin,endothelin and PDGF,partners in fibroblast activation[J].Circ Res,2010,106(11):1675-1680
[16]Abrass CK,Hansen KM,Patton BL.Lamimin alpha4-null mutant mice develop chronic kidney disease with persistent overexpression of platelet-derived growth factor[J].Am J Pathol,2010, 176(2):839-849
[17]Gauldie P,Bonniaud G,Sime K,et al.TGF-beta and the process of progress fibrosis[J].Biochem Soc Trans,2007,35(4):661-664
[18]刘秀玲,申爱荣.宫腔粘连患者子宫内膜组织中PDGF, TGF-β、TIMP-1的表达变化及意义.山东医药,2009,36(16)：39-41.
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[21]秦勇欣,陈百意.IGF-1对成纤维细胞功能和代谢的影响分析.国外医学呼吸系统分册,2006,36(6)：256-258
[22]王素梅,申爱荣IGF-1、IGF-1R在宫腔粘连患者子宫内膜中的表达研究.中国妇产科临床杂志,2009,10(3)：146-147
[23]韩延华,王晶晶,孙世君等.血小板衍生因子在宫腔粘连患者子宫内膜中的表达[J].中国生育健康杂志,2010,21(4)：208-210
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[27]李盛蒲.子宫输卵管造影检查对宫腔粘连诊断的价值分析[J].中国现代医学杂志,2003,13(5)：97-99
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[30]March C M,Israel R,March D.Hyeteroscopic management of intrauterine adhesions[J].Am J Gynaecol,1978,130(6):653-657
[31]Wamsteker K,De Block S,Diagnostic hysteroscopy:technique and documentation[M]//Sutton C,Diamond M,Endoscopic surgery for gynecologist.London:WB Saunders,1998:511-524
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[35]Roy K,Baruah J,Sharma JB,et al.Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Ashermans syndrome[J].Arch Gynecol Obstet,2010,281(2):355-361
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