长期应用小剂量米非司酮对子宫内膜形态和雌、孕激素受体的影响

本文利用HE染色和免疫组化方法结合计算机辅助图象分析技术观察了长期服用小剂量米非司酮对子宫内膜形态和雌、孕激素受体（ER、PR）的影响，15例子宫肌瘤患者于早卵泡期服用来非司酮（10例，10mg／日；5例，20mg／日）治疗，1～3个月后取内膜，另10例肌瘤患者取内膜作对照。结果：用药后所有的患者均闭经，内膜变薄，发育不良，无周期性改变，大部分基质致密，基质与腺体发育不同步，同时相间存在增殖与分泌期样改变，以增殖期样改变为主，腺体以分泌期样改变为主，腺体大小形态不一，但分泌不良。免疫组化显示内膜ER、PR明显分布不均，图象分析结果表明用药后内膜ER、PR相当于对照组增殖早中期水平。结果表明每日10mg米非司酮可明显抑制排卵并影响内膜成熟，在无孕激素存在的情况下，米非司酮有微弱的孕激素样作用。

The Effect of a Long-term Low-dose Administration of Mifepristone on Sex Steroid Receptors and Endometrial Morphology

The changes of sex steroid receptors and endometrial morphology following a long-term low -dose administration of mifepristone were studied by HE staining, immunohistochemistry and computer image analysis. Fifteen patients with uterine leiomyoma were treated with 10 mg (10 patient, for 3 months) and 20 mg (5 patient, for 1 to 3 months) mifepristone daily beginnin0 on day 1 to 3 of the menstrual cycle. Controls consisted of 10 patients with uterine leiomyomata.Results:10 mg and 20 mg mifepristone daily treated endometrium became thiner, bad proliferative and developed following ovarian acyclicity; the development of stroma and glands were asynchronous and the changes of proliferative and secretory phase homochronous. Stroma exhibited predominantly proliferative - like change with dense cellular stroma, endometrial glands with irregular size and shape and different epithelial types showed obvirously secreatory phase - like changes but hyposecretion. Immunohistostaining exhibited badly distributed progesterone and estrogen receptors in endometrium treated with mifepristone; immunostaining of ER and PR was basically equal to that of mid - or late - folicular phase compared with control. The results showed 10 mg of mifepristone daily could interfere morphology and function of endometrium,inhibit ovulation and endometrial maturity and mifepristone is a weak agonist in the absence of progesterone.