药物流产后子宫异常出血的发病机理研究

Study on the pathogenesis of uterine bleeding disorders after medical abortion

目的:探讨米非司酮药物流产后子宫出血与基质金属蛋白酶(MMP)-3、9,MMP抑制物(TIMP)-1及子宫自然杀伤(uNK)细胞的相关性。方法:选取自愿终止妊娠、停经≤8周的早孕妇女,自愿选择人工流产方法并相应处理后,根据情况将其分为负压吸宫组、药物流产不全组、药物流产完全组各20例。收集3组蜕膜组织并应用免疫组织化学方法检测MMP-3、MMP-9、TIMP-1、CD56的表达,图象分析仪半定量分析。结果:较负压吸宫组药物流产不全组出血区的MMP-3、MMP-9表达显著增强(P<0.01);TIMP-1的表达,显著减弱(P<0.01);uNK细胞的数量显著增多(P<0.01)。结论:药物流产不全者子宫内膜出血区的蜕膜细胞MMP-3、MMP-9增多,TIMP-1减少,两者比例失调导致细胞外基质退化,血管脆性增加,发生出血;另外uNK细胞数量异常增多,导致异常血管生成,孕囊与蜕膜剥离不全而引发出血。

Objective： To study the relationship of uterine bleeding disorders and matrix metalloproteiniase（MMP） and its inhibitors as well as uterine nature killer（uNK） cells in deciduas.Methods： The women within 8 weeks of intrauterine gestation underwent termination of pregnancy,then divided into three groups： vacuum aspiration group,incomplete medical abortion group and complete medical abortion group according to the methods and the results of induced abortion,20 women for each group.The immunohistochemical analysis was conducted to evaluated the expressions of MMP-3,MMP-9,TIMP-1 and CD56 in the deciduas.Results： In the sites of hemorrhage of the incomplete medical abortion group,the expressions of MMP-3,MMP-9 increased significantly（P0.01）;the expression of TIMP-1 decreased significantly（P0.01）;the number of the uNK cells increased（P0.01）.Conclusion： The abnormal expressions of MMPs and TIMP induce the alterations in the extracellular matrix and increase the fragility of the blood vessels,resulting in the occurrence of hemorrhage.Abnormal increase of the uNK cells causes abnormal vascularization,resulting in the occurrence of hemorrhage as well.