米非司酮终止早孕后对再次妊娠蜕膜ER、PR的影响

Influence on Estradiol and Progesterone Receptors in Human Decidua in the Next Pregnancy after Terminating Early Pregnancy by Mifepristone

目的 :探讨米非司酮配伍米索前列醇 (米索 )中止早孕后对再次妊娠早孕蜕膜雌激素受体 (ER)、孕激素受体 (PR)的影响。方法 :取停经 4 9d内、无口服米非司酮史妇女早孕蜕膜绒毛 2 0例 ,分为两组 (Ⅰ、Ⅱ组 )。另取有使用米非司酮抗早孕史再孕妇女蜕膜绒毛 2 0例 ,分为两组 (Ⅲ、Ⅳ组 )。其中Ⅰ、Ⅲ组行人工流产 ,Ⅱ、Ⅳ组行药物流产。绒毛组织均行HE染色光镜下观察 ,蜕膜组织应用免疫组织化学方法及电子计算机图像分析技术观察ER、PR的变化。结果 :①Ⅰ、Ⅲ组合体滋养细胞及细胞滋养细胞无水肿变性 ,间充质无异常染色。Ⅱ、Ⅳ组绒毛水肿变性明显。②早孕蜕膜ER、PR均位于大部分间质细胞及少数腺上皮细胞的胞核内。 4组受体水平积分Ⅰ、Ⅱ组间有显著差异 (P <0 .0 1) ;Ⅲ、Ⅳ组间有显著差异 (P <0 .0 1) ;Ⅰ、Ⅲ组间及Ⅱ、Ⅳ组间均无显著差异 (P >0 .0 5 )。结论 :①米非司酮配伍米索可引起早孕绒毛水肿变性坏死 ;②米非司酮配伍米索可使早孕蜕膜ER、PR水平下降 ,但月经恢复后ER、PR水平已回复至正常 ,再次妊娠后蜕膜ER、PR与未服用米非司酮及米索者早孕蜕膜ER、PR无差异。前次药物流产效果正常者 。

Objective: To investigate the effects of mifepristone in combination with misoprostol on estradiol and progesterone receptors in decidua after terminating early pregnancy again. Methods: Twenty decidua specimens were obtained from pregnant women (gestational age <49 days) who were not treated with mifepristone. The first group were given induced abortion, and the second was treated by mifepristone in combination with misprostol. In additional, twenty decidua specimens divded as above from pregnant women who had received mifepristone for abortion in the last six months. Then the specimens were given HE staining, observed with optical microscope. Immunocytochemical reaction of PR and ER in decidua was compared among four groups using computer image analysis technology. Results: ① The villi of mifepristone group (Ⅱ and Ⅳ) showed more extensive and severer degeneration than the villi of the control group (I and III) under optical microscopy. ② In the all group, the nuclei of the decidual cells was stained positively for ER and PR. The intergral values of receptors showed that it was significant difference between the Ⅰ and Ⅱ group, so as the Ⅲ and Ⅳ group. But it was no diffevence between Ⅰ and Ⅲ or Ⅱ and Ⅳ group. Conclusion: ① Mifepristone can result in the swelling and degeneration of decidual cells. ② Mifepristone may act through decreasing the decidual PR and ER level in the early pregnancy. But ER and PR have resumend to normal level after menstrual cycle resumes. ③ The decidual ER and PR are no difference between the next pregnancy and the first medical abortion.