米非司酮药物流产后子宫异常出血与内膜MMP-9、TIMP-1的关系研究

目的：研究米非司酮药物流产后子宫内膜基质金属蛋白酶-9（MMP-9）和基质金属蛋白酶特异性组织抑制物-1（TIMP-1）的表达变化,探讨药物流产后子宫异常出血的机理。方法：取药物流产（简称药流）后和吸宫术后子宫出血〉14天妇女各20例以及药物流产后子宫出血≤14天20例妇女的子宫内膜,应用免疫组化二步法测定子宫内膜MMP-9和TIMP-1的表达,对3组子宫内膜MMP-9和TIMP-1表达进行组织学积分测定。结果：药流非出血组、药流出血组和吸宫出血组子宫内膜组织中MMP-9的表达依次下降（P〈0.05）,TIMP-1表达3组间无差异,3组子宫内膜中MMP-9/TIMP-1组织学积分比值分别为1.47、1.00、1.14。MMP-9/TIMP-1比值药流出血组高于其它两组（P〈0.05）,而药流出血组和吸宫出血组之间子宫内膜MMP-9/TIMP-1比值无差异。结论：子宫内膜MMP-9的下降和MMP-9/TIMP-1比值降低与人工流产术后的子宫出血有关,并非是药物流产后子宫出血所特有的内膜局部因子改变。

Study on the Relationship between Abnormal Uterine Bleeding after Medical Abortion with Mifepristone and Endometrial MMP-9/TIMP-1

Objective:To determine the expression of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in endometrium after medical abortion using Mifepristone,and to explore the mechanism of abnormal uterine bleeding after medical abortion. Methods:Endometrial tissues were obtained from the cases with abnormal uterine bleeding > 14 days (20 cases with medical abortion and 20 cases with uterine aspiration),and 20 women with uterine bleeding ≤14 days after medical abortion,respectively. The expressions of MMP-9 and TIMP-1 proteins in endometrium were determined using immunohistochemistry,and all results of the 3 groups were evaluated by histological scores. Results:The levels of MMP-9 expression decreased gradually in the medical abortion group with normal bleeding,medical abortion group with abnormal bleeding and uterine aspiration group with abnormal bleeding,respectively,with statistical significance (P<0.05). And there was no statistical difference of TIMP-1 expression among the 3 groups. The ratios of MMP-9/TIMP-1 in the 3 groups were respectively 1.47,1.00 and 1.14. The ratio of MMP-9/TIMP-1 in the medical abortion group with abnormal bleeding was higher than the other 2 groups,with statistical significance (P<0.05),while there was no statistical difference of MMP-1/TIMP-1 between the latter 2 groups. Conclusion:The decline of MMP-9 expression in endometrium and the reduction of MMP-1/TIMP-1 are related with uterine bleeding after abortion (including medical abortion and induced abortion),which are not the specific changes of endometrial partial factors after medical abortion with abnormal uterine bleeding.