Zackrisson U, Brännström M, Granberg S, Janson P O, Collins W P, Bourne T H
Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg University, Sweden.
Ultrasound Obstet Gynecol. 1998 Jul;12(1):50-5. doi: 10.1046/j.1469-0705.1998.12010050.x.
Nitric oxide is a potent vasodilator and is involved in several physiological events during the female reproductive cycle.
The aim of this study was to determine the acute effects of a nitric oxide donor on ultrasound-derived indices of blood flow in the intact human uterus and ovaries during the follicular phase of the normal menstrual cycle.
The plan was to perform an observational study of six healthy volunteers, recruited during days 9-12 from day 1 of the last menstruation. Subjects were scanned transvaginally, with B-mode and color Doppler imaging around 12.00, and 2 h after the application of a transdermal glyceryl trinitrate (GTN) patch 10 mg/24 h. The patch was then removed and the subjects were rescanned 2 h later. END-POINTS: The main outcome measures were the peak systolic velocity (PSV), time-averaged maximum velocity (TAMV) and the pulsatility index (PI) derived from flow velocity waveforms, in the left and right main uterine arteries, a radial artery and subendometrial vessels, and from vessels at the rim of the dominant ovarian follicle.
One woman was scanned on day 9, two on day 10 and three on day 12 of the cycle. The median pretreatment values for endometrial thickness and follicular volumes were 7.2 mm (range 6.0-10.0 mm) and 3.1 ml (range 0.3-6.8 ml), respectively. GTN induced a significant (p < 0.05) increase in the PSV and TAMV in the subendometrial vessels in all subjects. There was a corresponding decrease in the PI in four cases. Changes in blood flow were reversible (50% of the changes in PSV, TAMV and PI were essentially reversed 2 h after the patch had been removed). In the uterine arteries, PSV and TAMV were significantly (p < 0.01) and progressively decreased with a concomitant significant (p < 0.01) increase in PI. There was also a tendency for the mean PI to decrease progressively in the vessels at the rim of the dominant follicle with decreased post-treatment values in four out of six subjects.
GTN induces a reversible increase in subendometrial blood flow velocity during days 9-12 of the menstrual cycle. The expected circadian decrease in uterine artery blood flow seemed to be partly interrupted by GTN treatment.
These data justify the implementation of randomized controlled studies to determine the potential beneficial effects of transdermal GTN on ovarian and uterine blood flow and function.
一氧化氮是一种强效血管舒张剂，参与女性生殖周期中的多种生理活动。
本研究旨在确定一氧化氮供体对正常月经周期卵泡期完整人体子宫和卵巢超声血流指标的急性影响。
计划对6名健康志愿者进行观察性研究，从末次月经第1天起第9至12天招募。受试者于12:00左右经阴道进行B型和彩色多普勒成像扫描，并在应用10mg/24h经皮硝酸甘油（GTN）贴片2小时后再次扫描。然后移除贴片，2小时后对受试者再次进行扫描。终点：主要观察指标为从流速波形得出的左右子宫主动脉、一条桡动脉和子宫内膜下血管以及优势卵泡边缘血管的收缩期峰值流速（PSV）、时间平均最大流速（TAMV）和搏动指数（PI）。
在月经周期的第9天对1名女性进行了扫描，第10天对2名女性进行了扫描，第12天对3名女性进行了扫描。子宫内膜厚度和卵泡体积的预处理中位数分别为7.2mm（范围6.0 - 10.0mm）和3.1ml（范围0.3 - 6.8ml）。GTN使所有受试者子宫内膜下血管的PSV和TAMV显著增加（p < 0.05）。4例受试者的PI相应降低。血流变化是可逆的（PSV、TAMV和PI变化的50%在移除贴片2小时后基本恢复）。在子宫动脉中，PSV和TAMV显著降低（p < 0.01）且逐渐下降，同时PI显著增加（p < 0.01）。在优势卵泡边缘血管中，平均PI也有逐渐降低的趋势，6名受试者中有4名受试者治疗后的数值降低。
GTN在月经周期的第9至12天可使子宫内膜下血流速度可逆性增加。GTN治疗似乎部分中断了子宫动脉血流预期的昼夜节律性下降。
这些数据证明有必要开展随机对照研究，以确定经皮GTN对卵巢和子宫血流及功能的潜在有益作用。
