米非司酮治疗失败异位妊娠患者输卵管雌孕激素受体表达的研究

Study on the Receptor Expressions of ER and PR in Fallopian Tube in Cases of Failure with Mifepristone for Ectopic Pregnancy

目的探讨米非司酮治疗异位妊娠失败的原因,从受体水平上为临床使用抗孕激素药物治疗异位妊娠提供理论依据。方法采用HE染色,镜下观察输卵管妊娠时输卵管的蜕膜反应,通过免疫组织化学方法研究妊娠部位管壁组织的雌激素受体、孕激素受体的表达。结果米非司酮治疗组和手术对照组的蜕膜化反应例数比宫内妊娠组明显减少(P<0.05);米非司酮治疗失败组输卵管雌激素受体的表达稍弱于手术对照组、宫内妊娠对照组,但三者之间的差别无统计学意义;米非司酮治疗失败组输卵管孕激素受体的表达弱于手术对照组,宫内妊娠对照组孕激素受体的表达明显强于手术对照组和米非司酮治疗组,三者比较差异有统计学意义(P<0.05)。结论异位妊娠输卵管组织薄弱,蜕膜反应较少,孕激素受体表达阳性率偏低,阳性强度很低,缺乏米非司酮作用的靶组织,故用米非司酮治疗异位妊娠理论依据不足。

Objective To investigate the reasons of failure with mifepristone in ectopic pregnancy treatment, and find theoretical reference on receptor level for anti-progestogen pharmacal therapy in clinical ectopic pregnancy treatment. Methods All the selected cases were divided into three groups, the mifepristone treatment failure group, the operation group and the normal pregnancy group. The decidua reaction in all the groups were observed with HE staining under microscope. The expressions of ER and PR in fallopian tube wall of pregnancy site during tubal pregnancy were measured with immunohistochemical method. The failure cases of mifepristone treatment were also measured. Results The decidua reactions in the mifepristone treatment group and the operation group were less than that in the normal pregnancy(P<0.05). The expression of ER was of no significant difference among the three groups. The expression of PR in the mifepristone treatment failure group was less than in the operation group, while the expression of PR in the normal pregnancy group is more than in other two groups.Both the differences were significant. Conclusion It was noticed of a weak tubal tissue, less decidua reaction, and low expression of PR in tubal pregnancy. So, it was not theoretically reasonable for mifepristone treatment to tubal pregnancy which may have little target tissue of mifepristone.