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目的:探讨不明原因复发性自然流产(RSA)患者的病因。方法:采用免疫组化法检测40例RSA患者及20例正常早孕妇女(对照组)的绒毛和蜕膜组织中Survivin、MMP-9及TIMP-3含量。结果:绒毛组织中Survivin、TIMP-3的表达水平RSA组高于对照组,差异有统计学意义(P<0.05),Survivin与TIMP-3存在相关关系(P<0.05);RSA组与对照组绒毛中MMP-9的表达差异无统计学意义(P>0.05)。RSA组与对照组蜕膜中Survivin的表达差异无统计学意义(P>0.05),RSA患者蜕膜组织中TIMP-3的表达水平高于对照组,MMP-9的表达水平低于对照组,差异有统计学意义(P<0.05)。在RSA组绒毛及蜕膜中mmp-9/timp-3的比值均低于对照组,差异有统计学意义(P<0.05)。结论:RSA组绒毛中Survivin过度表达可能与TIMP-3上调有关,TIMP-3上调使MMP-9与TIMP-3平衡失调,滋养细胞浸润力受抑,从而导致自然流产的发生。
Objective: To investigate the etiology of patients with unexplained recurrent spontaneous abortion (RSA). Methods: The expressions of Survivin, MMP-9 and TIMP-3 in villi and decidua of 40 RSA patients and 20 normal pregnant women (control group) were detected by immunohistochemistry. Results: The expression of Survivin and TIMP-3 in chorionic villi was higher in RSA group than that in control group (P <0.05), but there was a significant correlation between Survivin and TIMP-3 (P <0.05) The expression of MMP-9 in villus had no significant difference (P> 0.05). There was no significant difference in the expression of Survivin in the decidua between the RSA group and the control group (P> 0.05). The expression of TIMP-3 in the decidua tissue of RSA group was higher than that of the control group, while the expression of MMP-9 was lower than that of the control group The difference was statistically significant (P <0.05). The ratio of mmp-9 / timp-3 in the hair and decidua of RSA group was lower than that of the control group, the difference was statistically significant (P <0.05). CONCLUSIONS: Survivin overexpression in RSA group may be related to TIMP-3 upregulation. Upregulation of TIMP-3 may lead to imbalance of MMP-9 and TIMP-3 and suppression of trophoblast invasion, resulting in spontaneous abortion.