米非司酮对早孕蜕膜中TNF-α和NK细胞亚群的影响

EFFECT OF MIFEPRISTONE ON THE EXPRESSION OF TUMOR NECROSIS FACTOR-α AND NATURAL KILLER CELL SUBSETS IN DECIDUA OF EARLY PREGNANCY

①目的 观察应用米非司酮终止妊娠后子宫蜕膜中肿瘤坏死因子α(TNF α)和自然杀伤 (NK)细胞亚群 (CD+ 56CD-16,CD+ 56CD+ 16,CD-56CD+ 16)的变化 ,探讨米非司酮致流产的免疫作用机制。②方法 4 0例早孕药物流产妇女 ,给予口服米非司酮 2d ,总量 15 0mg ,第 3天加服米索前列醇 6 0 0 μg .采用流式细胞技术对蜕膜组织中NK细胞亚群CD+ 56CD-16,CD+ 56CD+ 16,CD-56CD+ 16及TNF α的表达进行检测。并与 4 0例同孕龄的人工流产妇女 (对照组 )对照。③结果 药物流产组CD+ 56CD-16,CD+ 56CD+ 16,CD-56CD+ 16的百分比分别为 (2 9.2 2± 8.0 5 ) % ,(7.2 4± 4 .11) % ,(10 .0 2± 3.10 ) % ,对照组分别为 (15 .87± 5 .31) % ,(4.34± 1.98) % ,(5 .82± 2 .34) % ,二者比较差异均有显著性(t=4 .0 2 0～ 8.75 5 ,P <0 .0 1)。TNF α的表达程度药物流产组为 (34.4 5± 7.6 5 ) % ,对照组为 (2 1.6 4± 7.4 3) % ,二者比较差异有显著性 (t=7.5 97,P <0 .0 1)。④结论 米非司酮主要作用于早孕母胎界面 ,可使蜕膜中NK细胞和TNF α表达增加 ,从而导致局部免疫微环境的变化 ,诱导胎儿免疫排斥反应 ,这可能是米非司酮致流产的免疫机制之一。

Objective\ To investigate the effect of mifepristone on the changes of tumor necrosis factor α(TNF α) and natural killer(NK) cells (CD + 56 CD - 16 ,CD + 56 CD + 16 ,CD - 56 CD + 16 )in decidua of early pregnancy and to study the mechanism of immunoaction of mifepristone induced abortion. \ Methods\ Forty women undergoing drug abortion were given mifepristone for 2 days with a total dose of 150mg. The expressions of NK cells and TNF α in decidua were assessed by flow cytometry. Forty artificial abortion women were taken as the controls.\ Results\ The expressions of CD + 56 CD - 16 , CD + 56 CD + 16 and CD - 56 CD + 16 were (29.22 ±8.05)%, ( 7.24± 4.11)% and (10.02±3.10)% respectively in drug abortion group, which were significantly higher than those in artificial abortion group: (15.87±5.31)%, (4.34±1.98)%, (5.82±2.34)% ( t=4.020-8.755, P <0.01) . The expression of TNF α in drug abortion group was (34.45 ±7.65)% and was higher than that in artificial abortion group (21.64±7.43)%. The differences were significant between the two groups ( t=7.597, P <0.01 ). \ Conclusion\ Mifepristone acts principally on feto maternal interface, and stimulates the secretion of NK cells and TNF α, which induce the disorder of decidual micro environment and it may be one of the aspects of the mechanism in medical abortion of mifepristone.