活血化瘀消癥杀胚中药对输卵管妊娠黏膜ER、PR及蜕膜组织Bcl-2的影响

目的]从输卵管黏膜雌激素受体(ER)、孕激素受体(PR)及蜕膜组织凋亡基因Bcl-2的角度探讨活血化瘀消癥杀胚中药治疗输卵管妊娠的作用机制。方法]根据输卵管妊娠病情影响因子评分模型和输卵管妊娠辨证治疗方案(国家中医药管理局重点专科异位妊娠协作分组组制定),收集30例(其中观察组15例,对照组15例)证属胎元阻络型,评分为8分的输卵管妊娠患者手术切除的输卵管组织,用免疫组化法检测输卵管黏膜组织中的雌激素受体(ER)、孕激素受体(PR)及蜕膜组织中凋亡基因Bcl-2。观察组15例为口服活血化瘀消癥杀胚中药3 d后手术切除的妊娠输卵管组织;对照组15例为未经任何药物治疗而直接进行手术切除的妊娠输卵管组织。结果]活血化瘀消癥杀胚中药可降低输卵管妊娠蜕膜组织中凋亡基因Bcl-2的表达水平(P<0.05),升高妊娠输卵管黏膜PR表达水平(P<0.05),对妊娠输卵管黏膜ER表达水平无影响(P>0.05)。结论]活血化瘀消癥杀胚中药可能通过阻碍Bcl-2的抗细胞凋亡的作用和降低输卵管黏膜对于胚胎组织的容受性这两种途径,促使输卵管妊娠胚胎组织的消亡。

Effects of Chinese medicine of activating blood circulation and dissolving stasis,eliminating mass and killing embryo on ER,PR expression in the fallopian mucosa and Bcl-2 expression in decidua

Objective] To discuss the mechanism of the Chinese medicine of activating blood circulation and dissolving stasis, eliminating mass and killing embryo on the fallopian pregnancy through the ER, PR expression on the fallopian pregnancy mucous membrane and Bcl-2 expression on the decidua. Methods] According to the scoring model about influence factors in pathologic condition of fallopian pregnancy and the differentiation scheme of treatment for fallopian pregnancy (formulated by specialist group of fallopian pregnancy, state administration of traditional Chinese medicine). 30 cases of fallopian tissues removed by surgery in patients with obstruction of meridian by embryo and having 8 of evaluating scores (observation group 15 cases, control group 15 cases) were collected and their expressions of ER and PR and the BcL-2 in decidua were determined with immunohistochemistry. In the observation group 15 cases of pregnant fallopian tissue removed by surgery were used for determining these parameters 3 days after oral taking traditional Chinese medicine; in control group 15 cases of the normal pregnant fallopian tissue without any treatment were used. Results] The Chinese medicine could reduce the expression of Bcl-2 in the decidua(P<0.05), increase the PR expression of fallopian tube (P<0.05),but had no obvious impact on ER expression of fallopian tube(P>0.05). Conclusion] Inducing apoptosis and reducing the accommodation of the fallopian mucosa may be the two effects of the Chinese medicine of activating blood circulation and dissolving stasis, eliminating mass and killing embryo.