目的：：研究宫腔粘连电切术联合小剂量阿司匹林对子宫动脉血流以及子宫内膜组织中 Smad2/3的影响.方法：选择2012年6月~2014年10月在我院接受宫腔粘连电切术治疗的重度宫腔粘连患者78例进行前瞻性研究,随机分为两组,观察组术后接受雌孕激素联合小剂量阿司匹林治疗,对照组术后接受雌孕激素治疗.治疗前后行超声检查并测定子宫动脉以及子宫内膜的血流参数,采集宫腔粘连组织并测定Smad2、Smad3以及下游分子的表达量,采集血清并测定细胞因子的含量.结果：治疗3个周期后的排卵日,观察组子宫动脉阻力指数(RI)、搏动指数(PI)均显著低于对照组(P＜0．05),子宫内膜血管化指数(VI)、血流指数(FI)、血管化血流指数(VFI)均显著高于对照组(P＜0．05)；观察组宫腔粘连组织中uPA表达量显著高于对照组(P＜0．05),Smad2、Smad3、PAI-1、ADAM15、ADAM17表达量显著低于对照组(P＜0．05),血清中转化生长因子-β(TGF-β)、血管内皮生长因子(VEGF)、结缔组织生长因子(CTGF)、胰岛素样生长因子-I(IGF-I)、肿瘤坏死因子-α(TNF-α)的含量显著低于对照组(P＜0．05).结论：宫腔粘连电切术联合小剂量阿司匹林治疗能够改善宫腔粘连患者术后子宫动脉及子宫内膜的血流状态,抑制Smad2/3信号通路所介导的细胞外基质沉积、预防宫腔再次粘连.%[ABSTRACT]Objective:To study the effect of transcervical resection of adhesion combined with low-dose aspirin on uter-ine artery blood flow and Smad2/3 in endometrial tissue.Methods:A total of 78 patients with severe intrauterine adhesions who received transcervical resection of adhesion in our hospital between June 2012 and October 2014 were prospectively studied and randomly divided into two groups,observation group of patients received postoperative estrogen-progestogen combined with low-dose aspirin therapy,and control group received postoperative estrogen-progestogen therapy.Ultrasound examination was conducted before and after treatment to determine uterine artery and endometrial blood flow parameters,intrauterine adhesion tissue was collected to detect the expression levels of Smad2 and Smad3 as well as downstream molecules,and serum was col-lected to determine the levels of cytokines.ResuIts:On the ovulation day after 3 cycles of treatment,uterine artery RI and PI of observation group were significantly lower than those of control group,and endometrial VI,FI and VFI were significantly higher than those of control group;uPA expression level in intrauterine adhesion tissue of observation group was significantly higher than that of control group,Smad2,Smad3,PAI-1,ADAM15 and ADAM17 expression levels were significantly lower than those of control group,and serum TGF-β,VEGF,CTGF,IGF-I and TNF-αlevels were significantly lower than those of control group.ConcIusions:Transcervical resection of adhesion combined with low-dose aspirin therapy can improve the postop-erative uterine artery and endometrial blood flow state,inhibit extracellular matrix deposition mediated by Smad2/3 signaling pathway and prevent intrauterine re-adhesion in patients with intrauterine adhesions.
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