补肾活血方联合宫腔灌注治疗对宫腔粘连相关机制TGF-β1、Smad2和Smad3 的影响分析

Effect of kidney-tonifying and blood-activating decoction combined with intrauterine perfusion on intrauterine adhesion mechanisms of TGF-β1，Smad2 and Smad3

摘要:

目的：探讨补肾活血方及宫腔灌注治疗对宫腔粘连患者临床症状的改善及对转化生长因子-β1（transforming growth fac－tor-beta1，TGF-β1）、Smad2和Smad3 的影响。方法：选择2017年7月至2018年7月重庆市中医院妇科收治的宫腔粘连患者60例，依据随机数字表法分为实验组和对照组，每组各30例。对照组采用戊酸雌二醇治疗，观察组采用补肾活血方联合丹参注射液宫腔灌注治疗。观察２组患者临床症状改善情况。采用ELISA法检测２组基质金属蛋白酶-2（matrix metalloproteinases-2，MMP-2）、基质金属蛋白酶-3（matrix metalloproteinases-3，MMP-3）及基质金属蛋白酶-9（matrix metalloproteinases-9，MMP-9）水平的变化。采用Western blot和Q-RT-PCR法检测2组患者治疗前后子宫内膜组织TGF-β1、Smad2和Smad3蛋白水平及mRNA水平。结果：与治疗前比较，２组患者子宫内膜厚度、MMP-2、MMP-3及MMP-9水平明显增加，子宫内膜血流参数（pul－satility index，PI ）、阻力指数（resistance index，RI）、粘连类型、粘连范围、月经情况及总分均有所降低。实验组子宫内膜厚度、MMP-2、MMP-3及MMP-9水平高于对照组，PI、RI、粘连类型、粘连范围、月经情况及总分均低于对照组（均P<0.05）。与治疗前比较，２组患者TGF-β1、Smad2和Smad3蛋白水平及mRNA水平均有所降低。实验组TGF-β1、Smad2和Smad3蛋白水平及mRNA水平均低于对照组（P<0.05）。结论：补肾活血方及宫腔灌注治疗可改善宫腔粘连血流参数，预防宫腔粘连的再次发生，其机制可能与上调MMP-2、MMP-3及MMP-9的表达，下调TGF-β1、Smad2和Smad3 表达水平有关。

Abstract:

Objective：To investigate the effect of kidney-tonifying and blood-activating decoction combined with intrauterine perfusion on improvement of clinical symptoms and transforming growth factor-beta1（TGF-β1），Smad2，and Smad3 in patients with intrauterine adhesions. Methods：A total of 60 patients with intrauterine adhesions admitted to our hospital from July 2017 to July 2018 were en－rolled and equally divided into the experimental group and the control group in accordance with the random number table. The con－trol group was treated with estradiol valerate，and the experimental group was treated with kidney-tonifying and blood-activating de－coction combined with intrauterine perfusion of Danshen injection. Clinical improvement in two groups was observed. Levels of matrix metalloproteinases-2（MMP-2），matrix metalloproteinases-3（MMP-3） and matrix metalloproteinases-9（MMP-9） in two groups were detected by ELISA. Levels of TGF-β1，Smad2 and Smad3 protein and mRNA in the endometrial tissues in two groups before and after treatment were detected by Western blot and Q-RT-PCR. Results：After treatment，the endometrium thickness，MMP-2，MMP-3 and MMP-9 levels were significantly increased in both groups，and the endometrial blood flow parameters of pulsatility index（PI），resistance index（RI），adhesion type，adhesion range，menstrual status and total score were all decreased. The en－dometrium thickness，MMP-2，MMP-3 and MMP-9 levels in the experimental group were higher than those in the control group；the PI，RI，adhesion type，adhesion range，menstrual status and total score were lower than those in the control group（all P<0.05）. After treatment，levels of TGF-β1，Smad2，and Smad3 protein and mRNA were reduced in both groups. Levels of TGF-β1，Smad2 and Smad3 protein and mRNA in the experimental group were lower than those in the control group（P<0.05）. Conclusion：Kidney-tonify－ing and blood-activating decoction and intrauterine perfusion can improve the blood flow parameters of intrauterine adhesion and prevent the recurrence of intrauterine adhesion. The mechanism may be related to the up-regulation of MMP-2，MMP-3 and MMP-9 expression，and the down-regulation of TGF-β1，Smad2 and Smad3 expression.