米非司酮下调不全流产患者蜕膜雌激素受体(ER)及孕激素受体(PR)表达

Mifepristone reduces the expression of estrogen receptor(ER)and progesterone receptor(PR) in decidual cells of incomplete induced abortion

目的了解不同剂量米非司酮对人工流产术后不全流产残留物中绒毛膜促性腺激素-β(β-human chorionic gonadotrophin,β-hCG)及雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)表达的影响。方法 60例2009年1至9月自愿在复旦大学附属妇产科医院计划生育门诊就诊的早孕人工流产术后不全流产妇女,随机分为4组:A、B、C组术前分别服用米非司酮1 400 mg(100mg,bid×7d)、700 mg(50mg,bid×7d)、350 mg(25 mg,bid×7d),D组为对照组,每组各1 5例。除D组直接行清宫术,其他组于停药后行清宫术。应用免疫组织化学EnVision法染色,半定量测定残留物中β-hCG及ER、PR水平。结果 4组β-hCG在绒毛滋养叶细胞胞质的表达差异无统计学意义(P>0.05)。ER、PR在蜕膜上皮细胞和间质细胞核中的表达,实验组较对照组表达均降低,差异均有统计学意义(P<0.05)。经两两秩和检验(修正α=0.05):ER在蜕膜上皮细胞核中的表达为A组较C、D组明显降低,差异有统计学意义(P<0.05);ER在蜕膜间质细胞核中的表达为A组较其他组明显降低,差异有统计学意义(P<0.05);A、B、C组较D组表达降低,差异有统计学意义(P<0.05)。PR在蜕膜上皮细胞核中,A、B、C组较D组表达降低,差异有统计学意义(P<0.05)。PR在蜕膜间质细胞核中的表达A组较其他组表达明显降低,差异有统计学意义(P<0.05);B组较C、D组表达降低,差异有统计学意义(P<0.05)。结论不同剂量的米非司酮对人工流产术后不全流产残留物中β-hCG的表达影响不明显。对蜕膜细胞中的ER、PR表达有抑制作用,此抑制作用可能是米非司酮治疗不全流产的作用机制之一。1 400 mg米非司酮治疗效果最显著。

Objective To study the impact of different dosages of mifepristone on expression of β-human chorionic gonadotrophin （βhCG）,estrogen receptor （ER） and progesterone receptor （PR） in remnants of incomplete induced abortion.Methods Data were collected from women after abortion who received treatment in family planning clinic of Obstetrics ＆ Gynecology Hospital of Fudan University from Jan to Sept.,2009.Sixty patients with incomplete induced abortion were diagnosed.They were randomly classified to 3 groups with different dosages of mifepristone ［350 mg （25 mg,bid×7d）,700 mg （50 mg,bid×7 d）,1 400 mg （100 mg,bid×7 d）］ and 1 control group,15 patients per group.In addition to group D which got curettage directly,the other groups got curettage after stop mifepristone.β-hCG,ER and PR expression level in the remnants were half quantitative measured by application of immunohistochemistry EnVision method dying.Results There was no significant statistical difference（P〉0.05） in the expression of β-hCG in villous trophoblast cytoplasmic among the 4 groups.Compared with control group,the expression of ER and PR in decidual epithelial cells and interstitial cell nuclei in experimental groups were all reduced with significant statistical difference （P〈0.05）.Pairwise comparison of rank sum test （adjust α=0.05） showed that group A was significantly reduced than group C and D in expression of ER in decidual epithelial cells with significant statistical difference （P〈0.05）;experimental groups were significantly reduced than control group in expression of ER in interstitial cell nuclei （P〈0.05）;experimental groups are significantly reduced than control group in expression of PR in decidual epithelial cells with significant statistical difference （P〈0.05）;group A was significantly reduced than other groups in expression of PR in interstitial cell nuclei with significant statistical difference （P〈0.05）;group B was reduced than group C and D in expression of PR in interstitial cell nuclei with significant statistical difference （P〈0.05）.Conclusions Miferpristone exhibits no obvious effect on the expression of β-hCG with different dosages of mifepristone on incomplete induced abortion.However,it inhibits the expression of ER and PR in decidual cell.This inhibitory effect of mifepristone on the expression of ER and PR might be one of its mechanisms in treating incomplete induced abortion.The most effective dosage we found is 1 400 mg.