早孕药物流产时米非司酮剂量和不同作用时间对蜕膜类固醇受体表达的影响

目的:探讨米非司酮不同给药方案对孕早期子宫蜕膜上类固醇受体表达的影响。方法:采用随机对照性临床研究,将150例早孕妇女按停经≤49d、50-56d、57-63d随机分入5组,分别口服100mg米非司酮,24±2h(A组)或48±2h(B组)后阴道置米索前列醇800μg;分别口服200mg米非司酮,24±2h(C组)或48±2h(D组)后阴道置米索前列醇800μg;并以负压吸宫术终止妊娠为对照(E组);每组30例(3个不同妊娠期限各10例)。用免疫组织化学SP法检测流产蜕膜组织上PR、ER、糖皮质激素受体(GR)的表达。结果:PR、ER在蜕膜上的表达不受米非司酮的用量和米索前列醇用药时间的影响;但米非司酮能抑制GR在蜕膜间质细胞上的表达,各实验组与对照组在各妊娠期限的差异均有统计学意义(P<0.05)。结论:米非司酮对PR、ER的表达无影响,对蜕膜间质中GR的表达有抑制作用;此抑制作用可能是米非司酮抗早孕作用机理之一。另100mg米非司酮24h后阴道置800μg米索前列醇终止≤63d妊娠是可行的。

Effects of Different Dosages and Intervals of Mifepristone on Expression of Steroid Hormone Receptor in Human Decidua from Medical Abortion in Early Pregnancy

To explore the effect of different schemes of mifepristone on the expressions of steroid receptor in the deciduas of early pregnancy. Methods: A total of 150 female patients in early pregnancy of menorrhea within 63 d were selected and categorized according to the period of menorrhea (≤49 d, 50-56 d, 57-63 d). Patients were randomly divided into 5 groups with 30 patients per group: oral administration of 100 mg mifepristone and later placement of 800 μg misoprostol in vagina after 24±2 h (group A) and 48±2 h (group B), respectively; 200 mg mifepristone (oral), and 800 μg misoprostol (vagina) after 24±2 h (group C) and 48±2 h (group D), respectively; while termination of pregnancy by using vacuum aspiration of uterus was as the control (group E). Immunohis-tochemistry (SP method) was performed to test the expression of PR, ER, glucocorticoid receptor (GR) in the deciduas. Results: In different gestational periods, between any two groups, miferistone had no effect on the expression of PR and ER in deciduas (P>0.05). While mifepristone inhibited expression of GR in interstitial cell of deciduas, the obvious disparity existed between the control and 4 trial groups (P<0.05). Conclusion: The expression of PR, ER and GR exist in the deciduas during human early pregnancy. Mifepristone does not affect the expressions of PR, ER, but it inhibits GR in mesenchyma. Therefore, it serves the basis of extending the time limit of medical abortion to 63 d, and mifepristone's inhibition on expression of GR also explains its anti-early pregnancy mechanism from a new angle.