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目的:探讨米非司酮对早孕绒毛蜕膜细胞凋亡、增殖的作用机制。方法:以20例药物流产患者为研究组,以20例非意愿妊娠要求行人工流产负压吸引刮宫术的患者为对照组,分别收集绒毛和蜕膜标本,应用原位末端标记法(TUNEL)检测细胞凋亡,并采用免疫组织化学方法检测bcl-2、bax、fas、fasL、增殖细胞核抗原(PCNA)5种蛋白在绒毛和蜕膜中的分布与表达强度,同时应用原位杂交法测定fas与fasLmRNA的分布与表达强度。结果:凋亡细胞在正常早孕绒毛合体滋养细胞中少量存在,蜕膜中偶见;绒毛、蜕膜中bcl-2、bax、fas、fasL、PCNA均有表达。采用米非司酮药物流产的绒毛合体滋养细胞及蜕膜间质及腺上皮细胞的凋亡显著增多,同时伴有促凋亡bax、fas、fasL蛋白及fasLmRNA含量的增加,而PCNA蛋白含量与C组比没有变化。结论:米非司酮不仅能促进早孕绒毛合体滋养细胞、蜕膜间质及腺上皮细胞的凋亡,而且主要通过Fas与FasL转录及翻译途径介导,bax表达增加也其也有一定的相关性,此可能为其抗早孕机制之一。
Objective: To investigate the mechanism of mifepristone on the apoptosis and proliferation of chorionic villus decidual cells in early pregnancy. Methods: A total of 20 patients with medical abortion were selected as research group. Twenty patients with unwanted pregnancy who were asked to undergo curettage by negative pressure were chosen as the control group. Villus and decidua specimens were collected. TUNEL, The apoptosis and expression of five proteins including bcl-2, bax, fas, fasL and proliferating cell nuclear antigen (PCNA) in villi and decidua were detected by immunohistochemistry. The in situ hybridization The distribution and expression intensity of fas and fasL mRNA. Results: Apoptotic cells were present in normal trophoblastic syncytiotrophoblast in early pregnancy, occasionally in decidua, and in bovine villi and decidua, bcl-2, bax, fas, fasL and PCNA. Apoptosis of villous syncytiotrophoblasts and decidua interstitial cells and glandular epithelial cells with mifepristone abortion were significantly increased, accompanied by an increase of bax, fas and fasL mRNA and fasL mRNA content, while PCNA protein content and C group than no change. Conclusion: Mifepristone can not only promote the apoptosis of syncytiotrophoblasts, decidua and glandular epithelial cells in early pregnancy, but also through the transcriptional and translational mechanisms of Fas and FasL. The increase of bax expression also has some correlation , Which may be one of its anti-pregnancy mechanism.