米非司酮药物流产后绒毛蜕膜细胞凋亡的相关研究

目的:探讨米非司酮对早孕绒毛蜕膜细胞凋亡、增殖的作用机制。方法:以20例药物流产患者为研究组,以20例非意愿妊娠要求行人工流产负压吸引刮宫术的患者为对照组,分别收集绒毛和蜕膜标本,应用原位末端标记法(TUNEL)检测细胞凋亡,并采用免疫组织化学方法检测bcl-2、bax、fas、fasL、增殖细胞核抗原(PCNA)5种蛋白在绒毛和蜕膜中的分布与表达强度,同时应用原位杂交法测定fas与fasLmRNA的分布与表达强度。结果:凋亡细胞在正常早孕绒毛合体滋养细胞中少量存在,蜕膜中偶见;绒毛、蜕膜中bcl-2、bax、fas、fasL、PCNA均有表达。采用米非司酮药物流产的绒毛合体滋养细胞及蜕膜间质及腺上皮细胞的凋亡显著增多,同时伴有促凋亡bax、fas、fasL蛋白及fasLmRNA含量的增加,而PCNA蛋白含量与C组比没有变化。结论:米非司酮不仅能促进早孕绒毛合体滋养细胞、蜕膜间质及腺上皮细胞的凋亡,而且主要通过Fas与FasL转录及翻译途径介导,bax表达增加也其也有一定的相关性,此可能为其抗早孕机制之一。

Apoptosis and Expression of Related Genes in Early Pregnant Chorionic Villi and Decidua

Objective： To investigate the mechanism of mifepristone on apoptosis and proliferation in early pregnant chorionic villi and decidua. Methods： The specimen of early pergnant chorinic villi and decidua was obtainedfrom 20 cases of mifepriston contragestation （study group）, 20 cases of requesting temination of pregnancy by curettage （the control）. The paraffin sections were used to defermine apoptotic cells by TdT-mediated dUTP-biotinnick and labeling method, to identify bcl-2, bax, fas, fasL and proliferating cell nuclear antigen （PCNA） by immunohistochemistry, to demonstrate fas andfasL mRNA by in situ hybridization. Results： In the control,apoptosis cells were mainly observed in syncytiotrophoblast, but not in cytotrophoblast cell, occationally observed in decidua cells. The antigen of bax, fas, fasL were present in syncytiotrophoblast cells and deciduawith lower amount. While bcl-2 antigen staning was strong in cytotrophoblastic cells and in decidual cells only. In study group, apoptotic cells were increased in syncytiotrophoblast cells of villi and visualized in deciduacells. The expression of fas, fasL and bax was also higher than that of the control. Conclusion： Mifepristone increased apoptosis in syncytiotrophoblast and decidua cells, but had no effect on the expression ofbcl-2 and PCNA.