茵陈蒿汤对妊娠期肝内胆汁淤积症胎盘中p53，Bax和Bcl-2表达的影响

Effect of Yinchenhao Decoction on the Expressions of P53, Bag and Bcl-2 in Placenta of Intra- hepatic Cholestasis of Pregnancy

【目的】探讨p53，Bax和Bcl-2在妊娠期肝内胆汁淤积症（ICP）胎盘组织上的表达及茵陈蒿汤对其调控作用。【方法】选择三组病例，即正常妊娠组30例（对照组）、ICP未用茵陈蒿汤治疗组30例（未服药组）和ICP用茵陈篙汤治疗组30例（服药组）。采用酶联免疫吸附试验（EI。ISA法）测定孕妇血清胆汁酸水平。采用免疫组化EnVision法分别检测三组胎盘组织细胞凋亡调控基因p53，Bax和Bcl-2的表达。【结果】①ICP患者血清胆汁酸水平明显高于正常对照组（P〈0．01）；ICP服药组治疗前与治疗后血清胆汁酸水平比较有差异（P〈O．01）。②未服药组p53、bax在胎盘组织的表达高于对照组和高于服药组，差异有统计学意义（P〈0．05）；③未服药组Bcl-2在胎盘组织的表达低于对照组，差异有统计学意义（P〈0．05）。【结论】①ICP患者的胎盘功能减退可能与胎盘组织细胞在外界有害物质作用下对细胞凋亡的敏感性增加有关系；②茵陈蒿汤治疗ICP可能是通过下调细胞凋亡调控基因bax和p53，延缓细胞凋亡，改善胎盘功能而发挥作用。

[Objective] To explore the expressions of P53, Bax and Bcl 2 in placenta tissue of intrahepatic cholestasis of pregnancy（ICP） and the regulation role of Yinchenhao decoction. [Methods]Three groups of ca- ses including normal pregnancy group（ n ：30, control group）, ICP without Yinchenhao decoction treatment group（ n ~ 30, non-drug treatment group） and ICP with Yinchenhao decoction treatment group（ n = 30, drug treatment group） were chosen. Enzyme-linked immunosorbent assay（ELISA） was used to determine serum bile acid level. The expressions of apoptosis controlling genes P53, Bax and Bcl-2 in placenta tissue of three groups were detected by using immunohistochemical EnVision method. [Results]Serum bile acid level in ICP patients was obviously higher than that in normal control group（ P ＊~0.01）. There was significant difference in serum bile acid level in ICP with drug treatment group between before and after treatment（ P d0.01）. The expressions of P53 and Bax in placenta tissue of non-drug treatment group were higher than those of drug treatment group, and there was significant difference（ P d0.05）. The expression of Bcl-2 in placenta tissue of non-drug treatment group was lower than that of normal control group, and there was significant difference（ P 〈0.05）. [Conclusion]Placental dysfunction of ICP patients may be related to the increasing of the sensitivity of placental tissue cell to apoptosis under the action of external harmful substances. Yinchenhao decoction for the treatment of ICP may play the role for delaying the cell apoptosis and improving placental function through down-regulating the expressions of cell apoptosis controlling gene Bax and p53.