Therapeutic effect of hydrotubation combined with bromocriptine in treatment of infertility patients caused by hyperprolactinemia complicated with tubal obstruction and its effect on serum luteinizing hormone and anti-acrosin antibody

doi:10.3877/cma.j.issn.1673-5250.2020.04.011

Objective

To explore the clinical effect of hydrotubation combined with bromocriptine in treatment of infertility patients caused by hyperprolactinemia (HPRL) and complicated with tubal obstruction, and its effect on serum luteinizing hormone (LH) and anti-acrosin antibody (AcrAb).

Methods

A total of 102 patients with infertility caused by HPRL and complicated with tubal obstruction in Mianyang Central Hospital from June 2017 to June 2018 were selected as research subjects. They were randomly divided into observation group (n=51) and control group (n=51) by random digits table method. Patients in observation group were treated with hydrotubation combined with bromocriptine. And patients in control group were treated with hydrotubation. The levels of serum LH and AcrAb were detected by chemiluminescence method and enzyme-linked immunosorbent assay. After treatment, the two groups were followed up for 1 year to observe their pregnancy situation. Duration of hydrotubation, intraoperative blood loss and postoperative ambulation time, levels of serum LH and AcrAb, and the time from the end of treatment to pregnancy between two groups were compared by independent-samples t test. Total effective rates of tubal obstruction, adverse reaction and pregnancy between two groups were compared by chi-square test. This study was approved by the Ethics Committee of Mianyang Central Hospital (Approval No. S-2018-022), and clinical research informed consent was signed with each patient. There were no significant differences in age, duration of infertility and other general clinical data between two groups (P>0.05).

Results

①There were no significant differences in duration of hydrotubation, intraoperative blood loss and postoperative ambulation time between two groups (P>0.05). ②The total effective rate of tubal obstruction in observation group was 82.3% (42/51), which was significantly higher than that of control group 64.7% (33/51), and the difference was statistically significant (χ²=4.080, P=0.043). ③Comparisons between two groups: after treatment, the serum LH level of observation group was (5.59±0.58) IU/L, which was significantly higher than those of control group (5.36±0.57) IU/L, and the serum AcrAb levels were (12.2±2.5) U/L, which was significantly lower than those of control group (14.2±2.9) U/L, and both the differences were statistically significant (t=2.002, P=0.048; t=3.743, P<0.001). Intra-group comparisons: after treatment, serum LH levels in two groups were significantly higher than those before treatment within group, while serum AcrAb levels were significantly lower than those before treatment within group, and all the differences were statistically significant (P<0.05). ④During 1-year follow-up after treatment, the pregnancy rate in observation group was 70.6% (36/51), which was significantly higher than that in control group 51.0% (26/51), the time from the end of treatment to pregnancy was (4.0±1.0) months, which was significantly shorter than that of control group (5.3±1.1) months, and both the differences were statistically significant (χ²=4.110, P=0.043; t=6.053, P<0.001). ⑤There was no significant difference in rate of adverse reaction related with treatment between two groups (P>0.05).

Conclusions

Hydrotubation combined with bromocriptine in treatment of patients with infertility caused by HPRL complicated with tubal obstruction has a good effect, and the pregnancy rate is increased. It can effectively improve serum levels of LH and AcrAb, but does not increase the rate of adverse reactions. Due to the relatively small sample size included in this study, the therapeutic effect of this regimen remains to be further confirmed by large-sample size, multi-center and randomized controlled trials.

Key words: Hyperprolactinemia, Tubal obstruction, Hydrotubation, Bromocriptine, Luteinizing hormone, Anti-acrosin antibody, Infertility, female

表1 2组HPRL所致不孕症合并输卵管阻塞患者输卵管通液术治疗的相关指标比较(±s)

组别	例数	持续时间(min)	术中出血量(mL)	术后下床活动时间(d)
观察组	51	30.8±18.1	11.4±4.5	1.03±0.10
对照组	51	29.6±17.3	11.5±4.7	1.01±0.07
t值	?	0.339	0.120	1.170
P值	?	0.735	0.905	0.245

表1 2组HPRL所致不孕症合并输卵管阻塞患者输卵管通液术治疗的相关指标比较(±s)

组别	例数	持续时间(min)	术中出血量(mL)	术后下床活动时间(d)
观察组	51	30.8±18.1	11.4±4.5	1.03±0.10
对照组	51	29.6±17.3	11.5±4.7	1.01±0.07
t值	?	0.339	0.120	1.170
P值	?	0.735	0.905	0.245

表2 2组HPRL所致不孕症合并输卵管阻塞患者输卵管阻塞治疗的总有效率比较[例数(%)]

组别	例数	治愈	有效	无效	总有效率
观察组	51	25(49.0)	17(33.3)	9(17.6)	42(82.3)
对照组	51	19(37.3)	14(27.4)	18(35.3)	33(64.7)
χ²值	?	—	—	—	4.080
P值	?	—	—	—	0.043

表2 2组HPRL所致不孕症合并输卵管阻塞患者输卵管阻塞治疗的总有效率比较[例数(%)]

组别	例数	治愈	有效	无效	总有效率
观察组	51	25(49.0)	17(33.3)	9(17.6)	42(82.3)
对照组	51	19(37.3)	14(27.4)	18(35.3)	33(64.7)
χ²值	?	—	—	—	4.080
P值	?	—	—	—	0.043

表3 2组HPRL所致不孕症合并输卵管阻塞患者治疗前、后血清LH与AcrAb水平的组内及组间比较(±s)

组别	例数	血清LH水平(IU/L)				血清AcrAb水平(U/L)
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
观察组	51	5.03±0.58	5.59±0.58	4.834	<0.001	18.5±3.6	12.2±2.5	10.168	<0.001
对照组	51	5.01±0.56	5.36±0.57	3.128	<0.001	18.3±3.6	14.2±2.9	6.283	<0.001
t值	?	0.177	2.002	?	?	0.267	3.743	?	?
P值	?	0.860	0.048	?	?	0.790	<0.001	?	?

表3 2组HPRL所致不孕症合并输卵管阻塞患者治疗前、后血清LH与AcrAb水平的组内及组间比较(±s)

组别	例数	血清LH水平(IU/L)				血清AcrAb水平(U/L)
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
观察组	51	5.03±0.58	5.59±0.58	4.834	<0.001	18.5±3.6	12.2±2.5	10.168	<0.001
对照组	51	5.01±0.56	5.36±0.57	3.128	<0.001	18.3±3.6	14.2±2.9	6.283	<0.001
t值	?	0.177	2.002	?	?	0.267	3.743	?	?
P值	?	0.860	0.048	?	?	0.790	<0.001	?	?

表4 治疗结束后，2组HPRL所致不孕症合并输卵管阻塞患者的妊娠率与治疗结束至妊娠的时间比较

组别	例数	妊娠[例数(%)]	治疗结束至妊娠的时间(月，±s)^a
观察组	51	36(70.6)	4.0±1.0
对照组	51	26(51.0)	5.3±1.1
检验值	?	χ²＝4.110	t＝6.053
P值	?	0.043	<0.001

表4 治疗结束后，2组HPRL所致不孕症合并输卵管阻塞患者的妊娠率与治疗结束至妊娠的时间比较

组别	例数	妊娠[例数(%)]	治疗结束至妊娠的时间(月，±s)^a
观察组	51	36(70.6)	4.0±1.0
对照组	51	26(51.0)	5.3±1.1
检验值	?	χ²＝4.110	t＝6.053
P值	?	0.043	<0.001

[1]	朱海燕，张海荣，沈祖楠，等. 900例不孕不育患者染色体核型分析[J]. 中华医学遗传学杂志，2015, 32(4): 583-584. DOI: 10.3760/cma.j.issn.1003-9406.2015.04.031.
[2]	Chua SJ, Danhof NA, Mochtar MH, et al. Age-related natural fertility outcomes in women over 35 years: a systematic review and individual participant data Meta-analysis [J]. Hum Reprod, 2020: deaa129 [2020-07-23]. DOI: 10.1093/humrep/deaa129. [published online ahead of print July 22, 2020]． URL
[3]	Zauner G, Girardi G. Potential causes of male and female infertility in Qatar [J]. J Reprod Immunol, 2020, 141: 103137 [2020-06-30]. DOI: 10.1016/j.jri.2020.103173. [published online ahead of print June 28, 2020]. URL
[4]	林姬，林立恒. 输卵管堵塞导致的不孕症患者行输卵管通液术的疗效观察[J]. 中国妇幼保健，2016, 31(21): 4521-4522. DOI: 10.7620/zgfybj.j.issn.1001-4411.2016.21.74.
[5]	杨智红，陈光元. 溴隐亭治疗高催乳素血症致不孕不育的疗效及对性激素水平的影响[J]. 海南医学，2018, 29(4): 554-555. DOI: 10.3969/j.issn.1003-6350.2018.04.035.
[6]	Choi J, Smitz J. Luteinizing hormone and human chorionic gonadotropin: origins of difference [J]. Mol Cell Endocrinol, 2014, 383(1-2): 203-213. DOI: 10.1016/j.mce.2013.12.009.
[7]	靳镭，徐蓓. 黄体生成素在卵泡发育中的作用及早卵泡期黄体生成素预处理[J]. 生殖医学杂志，2014, 23(12): 940-943. DOI: 10.3969/j.issn.1004-3845.2014.12.003.
[8]	吴晓红. 血清顶体蛋白酶抗体与精子蛋白17抗体在不孕不育症患者中的诊断价值[J]. 检验医学与临床，2016, 13(22): 3213-3214. DOI: 10.3969/j.issn.1672-9455.2016.22.032.
[9]	谢幸，苟文丽. 妇产科学[M]. 8版. 北京：人民卫生出版社，2013: 369.
[10]	罗福东，潘婉仪，周强. 化学发光免疫分析法检测黄体生成素、维生素B12和癌胚抗原的性能评价[J]. 实验与检验医学，2006, 24(5): 431-432. DOI: 10.3969/j.issn.1674-1129.2006.05.023.
[11]	Howe SE, Grider SL, Lynch DM, et al. Antisperm antibody binding to human acrosin: a study of patients with unexplained infertility [J]. Fertil Steril, 1991, 55(6): 1176-1182. DOI: 10.1095/biolreprod44.6.1189.
[12]	Bhat A, Byatt N. Infertility and perinatal loss: when the bough breaks [J]. Curr Psychiat Rep, 2016, 18(3): 31. DOI: 10.1007/s11920-016-0663-8.
[13]	Luk BH, Loke AY. The impact of infertility on the psychological well-being, marital relationships, sexual relationships, and quality of life of couples: a systematic review [J]. J Sex Marital Ther, 2015, 41(6) : 610-625. DOI: 10.1080/0092623X.2014.958789.
[14]	钱莹. 156对不孕不育症患者临床观察[J]. 中国妇幼保健，2016, 31(14): 2917-2918. DOI: 10.7620/zgfybj.j.issn.1001-4411.2016.14.54.
[15]	Langley FA. The fallopian tube: structure, function, pathology and management [J]. J Clin Pathol, 1970, 23(4): 376-376. DOI: 10.1136/jcp.23.4.376-a.
[16]	包成，柯荔宁. 输卵管结构病变引发不孕的诊疗研究进展[J]. 中国临床解剖学杂志，2014, 32(1): 115-116. DOI: 10.13418/j.issn.1001-165x.2014.01.029.
[17]	Goldman MB, Thornton KL, Ryley D, et al. A randomized clinical trial to determine optimal infertility treatment in older couples: the Forty and Over Treatment Trial (FORT-T) [J]. Fertil Steril, 2014, 101(6): 1574-1581.e1-2. DOI: 10.1016/j.fertnstert.2014.03.012.
[18]	陶雪峰，侯俊霞，崔世红. 宫腔镜下输卵管插管通液术在输卵管阻塞性不孕患者治疗中的优势[J]. 中国临床研究，2016, 29(1): 92-94. DOI: 10.13429/j.cnki.cjcr.2016.01.028.
[19]	李文香，安新涛，焦守凤，等. 宫腔镜下输卵管插管通液治疗不孕不育的临床疗效[J]. 中国性科学，2016, 25(9): 110-112. DOI: 10.3969/j.issn.1672-1993.2016.09.037.
[20]	Krysiak R, Okrzesik J, Okopien B. The effect of short-term metformin treatment on plasma prolactin levels in bromocriptine-treated patients with hyperprolactinaemia and impaired glucose tolerance: a pilot study [J]. Endocrine, 2015, 49(1): 242-249. DOI: 10.1007/s12020-014-0428-2.
[21]	Mabrouk SK, Abdellatif N. Clinical determination of bromocriptine 2.5 mg (parlodel^®) induced ovulation in atlas shepherd Bitch [J]. J Vet Sci Technol, 2018, 9(2): 517. DOI: 10.4172/2157-7579.1000517.
[22]	王慧玉，陈丽红. 溴隐亭不同给药时机对高泌乳素血症妇女促性腺激素诱导排卵的影响[J]. 中国临床药理学杂志，2015, 31(1): 3-4. DOI: 10.13699/j.cnki.1001-6821.2015.01.001.
[23]	Beltrame AL, Serafini P, Motta EL, et al. The effects of bromocriptine on VEGF, kidney function and ovarian hyperstimulation syndrome in in vitro fertilization patients: a pilot study [J]. Gynecol Endocrinol, 2013, 29(3): 201-204. DOI: 10.3109/09513590.2012.736554.
[24]	Liu X, Xie F, Zamah AM, et al. Multiple pathways mediate luteinizing hormone regulation of cGMP signaling in the mouse ovarian follicle [J]. Biol Reprod, 2014, 91(1): 9. DOI: 10.1095/biolreprod.113.116814.
[25]	李曼，温冬梅，王伟佳，等. AMH、FSH、LH、E2联合检测在不孕症患者卵巢储备功能中的预测价值[J]. 检验医学与临床，2017, 14(12): 1729-1731. DOI: 10.3969/j.issn.1672-9455.2017.12.017.
[26]	Veaute C, Liu DY, Furlong LI, et al. Anti-human proacrosin antibody inhibits the zona pellucida (ZP)-induced acrosome reaction of ZP-bound spermatozoa [J]. Fertil Steril, 2010, 93(7): 2456-2459. DOI: 10.1016/j.fertnstert.2009.08.040.
[27]	Feng S, Xu L, Xu C, et al. Role of acrAB in antibiotic resistance of Haemophilus parasuis serovar 4 [J]. Vet J, 2014, 202(1): 191-194. DOI: 10.1016/j.tvjl.2014.05.045.
[28]	张婧楠. 腹腔镜下分粘加输卵管通液术治疗输卵管阻塞性不孕的临床价值[J]. 中国卫生标准管理，2015, 5(23): 29-30. DOI: 10.3969/j.issn.1674-9316.2015.23.019
[29]	杨晋蓉，谢珊莉，张英. 腹腔镜联合输卵管术中通液治疗输卵管性不孕患者的临床观察[J]. 西部医学，2011, 23(9): 1759-1760. DOI: 10.3969/j.issn.1672-3511.2011.09.056.
[30]	田普宁. 输卵管通液术对输卵管堵塞致不孕症患者妊娠率的影响[J]. 临床医学研究与实践，2016, 1(4): 61.
[31]	朱素芹，郑备红，陈晓菁，等. 经溴隐亭治疗的垂体泌乳素瘤患者行体外受精-胚胎移植的临床研究[J]. 海峡药学，2016, 28(7): 113-114. DOI: 10.3969/j.issn.1006-3765.2016.07.049.

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