Carvajal Jorge Andrés, Zambrano María José, Theodor Nur Mónica, Moreno Luis Emilio, Olguín Thiare Rosario, Vanhauwaert Paula Sofía, Rojas Nevenka Belén, Delpiano Ana María
1 Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Reprod Sci. 2017 Apr;24(4):635-640. doi: 10.1177/1933719116667221. Epub 2016 Sep 27.
Many pharmacological agents have been investigated to manage preterm labor; we postulate that a combination of tocolytic drugs may achieve a better effect in the prevention of uterine contractions without dose-dependent adverse effects. The aim of this study was to evaluate the inhibitory effect of dual combinations of tocolytics in vitro. Human myometrium was obtained during elective cesarean sections (term without labor; n = 40). Myometrial strips were placed in organ baths for the measurement of isometric tension. Contractile activity was induced by oxytocin (10 mol/L), then a concentration-response curve to single or dual combinations of tocolytics was started. All studied tocolytics (nifedipine, ritodrine, nitroglycerin, atosiban, and NS-1619), when used alone, significantly inhibited myometrial contractions. When combined, nifedipine plus ritodrine produced a significantly greater inhibition of contractility than each drug alone in the midrange of concentrations. The combination of nifedipine plus nitroglycerin or nifedipine plus atosiban produced a significantly greater inhibition than nitroglycerin or atosiban alone but not greater than nifedipine. The combination of nifedipine plus NS-1619 (Ca-activated K [BK] channel opener) reduced the inhibitory effect of each drug. We concluded that a selected combination of tocolytics (nifedipine plus ritodrine) produced a significantly greater inhibitory effect on contractility than each drug alone at intermediate concentrations. Thus, specific combinations of tocolytics with different intracellular signaling pathways may have a synergic effect constituting a provocative new option for preterm labor treatment.
许多药物制剂已被研究用于治疗早产;我们推测,宫缩抑制剂联合使用可能在预防子宫收缩方面取得更好的效果,且无剂量依赖性不良反应。本研究的目的是评估宫缩抑制剂双重组合在体外的抑制作用。在择期剖宫产术中获取人子宫肌层(足月未临产;n = 40)。将子宫肌条置于器官浴槽中测量等长张力。用缩宫素(10 μmol/L)诱导收缩活性,然后开始绘制单一或双重组合宫缩抑制剂的浓度 - 反应曲线。所有研究的宫缩抑制剂(硝苯地平、利托君、硝酸甘油、阿托西班和NS - 1619)单独使用时均能显著抑制子宫肌层收缩。联合使用时,在中等浓度范围内,硝苯地平加 利托君对收缩性的抑制作用明显大于每种药物单独使用时。硝苯地平加硝酸甘油或硝苯地平加阿托西班的组合产生的抑制作用明显大于硝酸甘油或阿托西班单独使用时,但不大于硝苯地平。硝苯地平加NS - 1619(钙激活钾[BK]通道开放剂)的组合降低了每种药物的抑制作用。我们得出结论,在中等浓度下,选定的宫缩抑制剂组合(硝苯地平加利托君)对收缩性的抑制作用明显大于每种药物单独使用时。因此,具有不同细胞内信号通路的宫缩抑制剂的特定组合可能具有协同作用,为早产治疗提供了一个引人注目的新选择。