米非司酮抑制葡萄胎血管内皮生长因子与微血管密度生成及其对临床预后的影响

Inhibition of mifepristone on the expression of vascular endothelial growth factor and microvessel density and effect of prognosis in hydatidiform mole

目的通过研究米非司酮治疗葡萄胎前后血管内皮生长因子（VEGF）及微血管密度（MVD）的改变,探讨米非司酮对滋养细胞肿瘤组织微血管生成的影响,寻求妊娠滋养细胞肿瘤治疗新途径。方法应用免疫组织化学方法染色检测32例葡萄胎组织的VEGF表达及MVD的改变;以正常早孕人工流产胚胎组织30例作为对照组。选取葡萄胎组织VEGF阳性表达病例11例,给予米非司酮治疗,1周后再次清宫,取组织重复染色,观察VEGF染色及MVD情况,分析米非司酮治疗对葡萄胎组织VEGF及MVD的影响。结果葡萄胎组织VEGF表达阳性率为34.4%,高于正常早孕人工流产胚胎组织的6.7%,VEGF阳性表达区多位于滋养细胞增生区或向正常组织浸润的边缘。米非司酮治疗前、后MVD值分别为43.03±10.11和21.32±8.03,差异有统计学意义（P〈0.05）。全部治疗病例随访13～37个月,无一例进展成侵蚀性葡萄胎。结论葡萄胎组织VEGF高表达可能与肿瘤性滋养细胞的浸润性有关,米非司酮对葡萄胎组织新生血管形成具有抑制作用,对预后未见不良影响。

Objective To study the changes of the expression of vascular endothelial growth factor （ VEGF） and microvessel density （ MVD ） before and after treatment for hydatidiform mole, and to evaluate the inhibitory action of mifepristone to the angiopoiesis and explore the new therapeutic methods in the treatment of trophoblastic tumor. Methods The expressions of VEGF and MVD were checked by means of immunohistochemistry in the tissue of hydatidiform mole of 32 cases. 30 cases of normal early embryonic tissue were taken as controls. 11 cases of the positive expression of VEGF were chosen and treated with mifepristone. The expressions of VEGF and MVD were checked one week after treatment and were analyzed repeatedly. Results The positive rate of the expression of VEGF was 34.4% in the tiaaul of hydalidifrom wole, which was higher than that of the expression of VEGF in early embryonic tissue （ 6.7% ）. The areas of the expression of VEGF were located at the zone of trophoblastic cell mutiplication and the invasive edges to normal tissue. The MVD were 43.03 ± 10.11 and 21.32 ± 8.03 before and after mifepristone treatment respectively （ P 〈 0.05 ）. All cases were followed up for 13 - 37 months, and no case progressed to invasive hydatidiform mole. Conclusion The expressions of VEGF are related with the potential invasive ability of the trophoblastic cell in trophoblastic tumor. The inhibitory effect of mifepristone on the angiopoiesis are approred. There are no adverse effects on the prognosis of hydatidiform mole.