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目的:观察服用米非司酮后的非孕妇女宫颈扩张度的改变及MMP-9、MMP-2、TIMP-1在宫颈组织中的表达,探讨米非司酮是否具有促非孕妇女宫颈成熟的作用及其相关机制。方法:①把90例要求行诊断性刮宫的非孕妇女随机分为A1、B1、C1三组各30例,分别为对照组、服用米非司酮组及服用米索组;所有患者均用扩宫棒先进行非用力宫颈最大扩张度的测定,48 h后行诊断性刮宫术,并于手术前再次测定宫颈非用力最大扩张度,观察三组不用力宫颈最大扩张度的变化。②A1、B1、C1组诊刮术前取部分宫颈组织作为标本(共56例),分别作为B2、C2、D2组,同时取17例非诊刮行全子宫切除患者A2组的部分宫颈组织作阴性对照,显微镜下观察四组宫颈的形态学变化,采用免疫组化Elivison二步法检测宫颈组织的MMP-9、MMP-2及TIMP-I的表达。结果:①C2组用药前后宫颈扩张的差异与A2,B2组相比有统计学意义,与D2组相比差异没有统计学意义;②C2组和D2组镜下显示组织水肿疏松,间隙增宽,毛细血管扩张,毛细血管中及周围可见较多的中性粒细胞及浆细胞浸润,A2组未观察到此改变,B2组可见轻度组织水肿改变,炎性细胞浸润不明显;C2组宫颈组织中的MMP-9的表达明显高于A2组及B2组,而与D2组无明显差异;MMP-2、TIMP-1在四组中的表达差异均不明显。结论:米非司酮有促进非孕妇女宫颈成熟的作用,MMP-9参与了此过程,而此药对MMP-2及TIMP-1的表达没有影响,米非司酮能促宫颈成熟可能与它的抗孕作用相关。
Objective: To observe the cervical dilatation of non-pregnant women after taking mifepristone and the expression of MMP-9, MMP-2 and TIMP-1 in cervical tissue and to explore whether mifepristone promotes cervical ripening in non-pregnant women The role and its related mechanisms. Methods: ①All 90 non-pregnant women who required diagnostic curettage were randomly divided into A1, B1 and C1 groups of 30 patients, which were control group, mifepristone group and misoprostol group, all patients Enlarged rod first determination of the maximum non-cervical dilatation, 48 h after the diagnosis of curettage, and again before surgery to determine the maximum non-cervical dilatation, observed the three groups did not force the maximum degree of cervical dilation changes. ②A1, B1, C1 group before taking curettage cervical tissue as a sample (a total of 56 cases), respectively, as B2, C2, D2 group, taking 17 cases of non-curettage line total hysterectomy A2 group of cervical tissue The morphological changes of the four groups were observed under a microscope. The expression of MMP-9, MMP-2 and TIMP-1 in cervical tissues was detected by immunohistochemical Elivison two-step method. Results: ①The difference of cervical dilation before and after treatment in C2 group was statistically significant compared with that in A2 and B2 group, and there was no significant difference between D2 group and C2 group. ②C2 and D2 showed microscopic edema, widened gap and capillary Vasodilatation, more visible in the capillaries and surrounding neutrophils and plasma cells infiltration, A2 group did not observe this change, B2 group showed mild changes in edema, infiltration of inflammatory cells was not obvious; C2 group of cervical tissue The expression of MMP-9 was significantly higher in group A2 and group B2 than in group D2, but there was no significant difference in MMP-2 and TIMP-1 among the four groups. Conclusion: Mifepristone can promote cervical maturation in non-pregnant women. MMP-9 participates in this process, and this drug has no effect on the expression of MMP-2 and TIMP-1. Mifepristone may promote cervical ripening Its anti-pregnancy effect.