米非司酮药物流产后子宫内膜雌激素和孕激素受体亚型观察

目的 研究药物流产(简称药流)、手术人工流产(简称人流)后妇女子宫内膜雌激素受体(ER)、孕激素受体(PR)各亚型表达,探讨各亚型的表达与出血的关系,为防治出血副反应提供理论依据。方法 取药物流产和手术人工流产后子宫出血时间≥16d妇女各15例及手术人工流产后子宫出血时间≤10d 15例妇女的子宫内膜,应用免疫组化链霉素标记生物素过氧化物酶法(SP法)测定子宫内膜ER、PR各亚型的表达及定位情况,对药流组、人流出血组、对照组等3组ER、PR各亚型表达进行组织学积分测定。结果 3组子宫内膜：ERα、ERβ、PR—A、PR—B组织学积分分别如下：药流组为166．7(88．5)、161．5(84)、180．0(109)、136．5(119．0),对照组为306．7(45．9)、230．0(75．0)、224．．2(57)、389．6(106．6)。人流出血组为109．4(114．6)、225．0(120．0)、175．5(225)、50．0(89．0)。药流组ERα、ERβ、PR—B比对照组低,人流出血组ERα、PR—B比对照组低,但ERβ的组织学积分人流出血组与对照组相比差异无显著性意义。3组子宫内膜ERα、ERβ、PR—A和PR—B腺体／间质组织学积分比值差异无显著性意义。结论 子宫内膜ERα、PR—B、ERβ表达降低可能与米非司酮药物流产后子宫出血时间长有关。负压吸引人流后妇女子宫内膜ERα、PR-B表达降低,可能与子宫出血时间过长有关。人流后子宫内膜腺体和间质亚型的表达变化是同步发生的。

The study on endometrial estrogen receptor and progesterone receptor isoforms in medical abortion women

OBJECTIVE: To determine the expression and location of estrogen and progesterone receptor isoforms in the endometrium after abortion and discuss the relationship between the changes of isoforms and prolonged uterine bleeding after medical abortion. METHODS: 45 endometrium biopsy were obtained from 15 women with prolonged bleeding after medical abortion, 15 women with prolonged bleeding after vacuum aspiration and 15 without prolonged bleeding after vacuum aspiration as control group. Immunohistochemical staining intensity of ER alpha, ER beta, PR-A and PR-B in endometrium were compared among these groups, as medical abortion group, surgical abortion group and control group. RESULTS: The endometrial ER alpha, ER beta, PR-A and PR-B H-Scores of medical abortion group were 166.7 (88.5), 161.5 (84), 180.0 (109) and 136.5 (119.0), The endometrial ER alpha, ER beta, PR-A and PR-B H-Scores of control group were 306.7 (45.9), 230.0 (75.0), 224.2 (57) and 389.6 (106.6). The endometrial ER alpha, ER beta, PR-A and PR-B H-Scores of surgical abortion group were 109.4 (114.6), 225.0 (120.0), 175.5 (225) and 50.0 (89.0). The endometrial ER alpha, ER beta, PR-B H-Scores of medical abortion group were significantly lower than those of control group. And in surgical abortion group ER alpha and PR-B H-Scores were significantly lower than those in control group. But there was no significant difference between ER beta H-Scores of surgical abortion group and control group. There were no significant differences of ER and PR isoforms level ratios of endometrial glands to endometrial stroma among three groups. CONCLUSIONS: The decreased ER alpha, ER beta and PR-B levels in the human endometrium may be related to prolonged uterine bleeding after medical abortion by mifepristone accompanied with misopristol. The endometrial ER alpha, PR-B decreased in women after vacuum aspiration abortion may be related to abnormal prolonged uterine bleeding. The changes of endometrial ER, PR isoforms in glands and stroma were simultaneous after medical abortion and surgical abortion.