米非司酮顿服后不同时间对早孕蜕膜形态及类固醇受体表达的影响

目的探讨药物流产中缩短米非司酮用药时间的可行性。方法将80例因非意愿妊娠自愿要求终止早孕的女性随机分为4组:对照组(直接负压吸宫术)、用药后12 h组、24 h组、48 h组,3个用药组顿服米非司酮150 mg,于不同时间行负压吸引术,留取各组蜕膜组织。应用光学显微镜、透射电子显微镜观察4组蜕膜组织的形态学改变,应用免疫组织化学方法和计算机图像分析系统检测四组蜕膜组织中类固醇受体的表达。结果 3个用药组蜕膜细胞变性、坏死,间质水肿、出血,毛细血管扩张充血。对照组蜕膜组织中雌激素受体(ER)和孕激素受体(PR)阳性染色位于大部分蜕膜细胞及少数腺上皮细胞,用药后12 h组、24 h组、48 h组蛋白表达均低于对照组,差异有统计学意义(P0.05),而这3组之间无统计学差异(P0.05)。结论米非司酮用药后12 h蜕膜组织变性坏死,蛋白表达受到抑制,为临床缩短药物流产用药时间提供了一定的理论参数。

Effects of shortening the time of mifepristone on the ultrastructure and the expression of steroid receptors in human decidua tissue in early pregnancy

Objective To explore the feasibility of shortening the time ofmifepristone in abortion.Mehtods Eighty women who desired to terminate the early pregnancy were divided into four groups:control group,12 h group,24 h group,48 h group.The decidua tissues were collected after uterine aspiration.The morphological change of decidua tissue was observed by light microscope and transmission electron microscope.The expression of estrogen receptor (ER),progesterone receptor (PR) in decidua tissue were detected by immunohistochemistry technique and computer image analysis system.Results Three medication groups showed that the decidual cells degenerate,necrosis,interstitial edema and telangiectasis.In decidua tissue of control group,the expression of ER and PR was mainly in the decidual cell and a few in epithelial cells,which were significant lower in the three medication groups than in control group (P＜0.05),and there was no difference among the three medication groups (P＞0.05).Conclusion The decidua tissues have turned to dropsy,degenerate and necrosis by 12 h after oral mifepristone.And the expressions of ER and PR have already been inhibited.It is indicated that shortening the time of mifepristone in medical abortion provides a certain theoretical parameters.