引产分娩胎盘中相关活性物质的表达及其意义

目的:观察不同用药方式中期引产胎盘的结构变化,并检测胎盘中活性物质的免疫组化表达,探讨引产分娩的相关机理。方法:收集妊娠16~28W胎盘组织共25例,分3组:羊膜腔内注射依沙吖啶引产组、注射依沙吖啶并配伍口服米非司酮引产组和正常足月分娩组。取新鲜胎盘,多聚甲醛固定,常规石蜡切片和HE染色;免疫组化SP法检测Bcl-2、Bax、Caspase-9、Fas-L、EGFR、CD68和β-hCG在胎盘的表达特征。结果:用药物引产组胎盘比正常组胎盘表现更严重的组织变性、坏死以及炎性浸润;几种凋亡相关因子的表达显示阳性增强,CD68阳性显示的绒毛Hofbauer细胞较足月胎盘大量增多,EGFR和β-hCG的表达也均明显较正常组活跃。结论:引产的分娩发动可能是药物对胎盘组织造成的严重炎症性损伤及主要引起滋养细胞过度凋亡,最终导致胎盘功能骤然下降的过程。

Expression of Interrelated Polypeptides in the Placentas during Midtrimester Abortion

Objective:To detect the expression of several biologic factors that related to delivery in the placenta during midtrimester abortion, and to discuss the mechanism of abortion delivery. Methods: 25 specimens of placentas were obtained and divided into three groups: group1: Rivanol injection intra-amniotically, group2: added mifepristone after Rivanol injection, group3: normal control group of placenta. The expressions of Bcl-2, Bax, Caspase-9, Fas-L, EGFR, CD68 and β-HCG were examined by immunohistochemistry. Results: The placentas that delivered after Rivanol injection were manifest more serious inflammation than that in the control group. It was shown that the positive reactions of Bcl-2 and Bax, which related to cell apoptosis, displayed on decidua and syncytiotrophoblast of placentas. The positive reactions of Fas-L and CD68(in Hofbauer cell)both were stronger in the placentas of Rivanol injection than that in term pregnancies. EGFR and -hCG distributed extensively in syncytiotrophoblast were obviously active during midtrimester abortion. Conclusion: It is showed that serious inflammation of placenta and inordinate cell apoptosis in syncytiotrophoblasts may disturb normal function of placenta and then results in the delivery of midtrimester abortion.