自然流产病例的绒毛与蜕膜细胞增殖和细胞凋亡的研究

目的　从细胞增殖与细胞凋亡的角度探讨自然流产的发生机制。方法　对 30例正常早孕吸宫流产病例和 30例自然流产病例的绒毛与蜕膜组织进行研究。常规光镜观察细胞形态学变化 ;免疫组织化学S P法检测增殖细胞核抗原 (PCNA)在细胞中的表达 ;用DNA缺口原位未端标记技术 (TUNEL)检测细胞凋亡 ;免疫组化S P法检测bcl 2 bax基因蛋白表达率比值。结果　自然流产绒毛组织形态学结构均出现程度不同的退行性改变 ,绒毛的细胞滋养细胞及蜕膜中增殖指数 (PI)较正常早孕时明显减少 (P <0 0 1) ,而合体滋养细胞中从未发生过增殖 ,PI为 0 ;与此相反自然流产绒毛的细胞滋养细胞、合体滋养细胞及蜕膜中凋亡指数 (AI)较正常早孕时明显增多 (P <0 0 5 ,P <0 0 1) ,同时 ,早孕流产的绒毛及蜕膜中促 /抑凋亡基因bcl 2 bax表达率的比值也较正常早孕时下降 (P <0 0 5 ,P <0 0 1) ,结果与细胞凋亡的发生一致。结论　细胞增殖和凋亡可能在孕卵发育过程中起着重要作用 ,绒毛和蜕膜组织中大量的细胞凋亡是其形态学退变的根本 ,并进而阻碍了孕卵的发育。

Apoptosis and proliferation in human chorionic villi and deciduae during spontaneous abortion

Objective To investigate the mechanism of spontaneous abortion in early pregnancy from apoptosis and proliferation.Methods Apoptosis and proliferation in early pregnant chorionic villi and deciduae from surgical aspiration and spontaneous abortion were studied. Histological changes were observed with light microscopy. Proliferating cell nuclear antigen (PCNA) was assayed by immunohistochemical staining; apoptosis cell death was detected by using DNA in situ terminal deoxynucleotidyl transferas mediated dUTP biotin nick ending labeling(TUNEL); both bcl 2 and bax gene protein were detected by using immunohistochemistyry. Results In chorionic villi after spontaneous abortion, there were extensive pathological changes in cell morphology. In spontaneous abortion, proliferating indexes of cytotrophoblasts and deciduas decreased in comparison with their counterparts in surgical aspiration ( P <0.01), and proliferating indexes of syncytiotrophoblasts were 0. While apoptosis indexes of cytotrophoblasts?syncytiotrophoblasts and deciduas were increased in spontaneous abortion by comparision with their counterpants in surgical aspiration ( P <0.05, P <0.01) , and both villi and decidua bcl 2/bax ratios were decreased compared with their counterparts in surgical aspiratio ( P <0.05, P <0.01), which was in consist with apoptosis. Conclusion Proliferation and apoptosis might play crucial roles in embryonic development and wastage during the first trimester of normal pregnancy. Apoptisis of a large population of cells in villi and deciduae might be the ultimate cause of morpholegical changes, and then prevent the development of human conceptus.