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目的:探讨米非司酮药流产后子宫出血与蜕膜基质金属蛋白酶-3(MMP-3)、基质金属蛋白酶-9(MMP-9)及其抑制物-1(TIMP-1)表达含量变化的关系。方法:选取要求终止妊娠的、停经8周之内的早孕妇女,自愿选择药物流产或人工流产两种方法之一,分为人工流产组、药流不全组、药流完全组各20例。收集3组蜕膜组织采用10%甲醛固定,石蜡包埋,应用免疫组织化学方法检测MMP-3、MMP-9、TIMP-1的表达,图象分析仪定量分析。结果:MMP-3、MMP-9和TIMP-1主要分布于子宫蜕膜上皮细胞、腺上皮及基质细胞的细胞浆内。药流不全出血区MMP-3、MMP-9的表达强度显著增强(P<0.01);TIMP-1的表达强度显著减弱(P<0.01)。结论:米非司酮作用于蜕膜上皮细胞、腺上皮细胞及基质细胞使其表达MMP-3、MMP-9增多,TIMP-1减少,且两者比例失调,导致细胞外基质退化,血管脆性增加,发生出血。
Objective: To investigate the changes of the expression of matrix metalloproteinase-3 (MMP-3), matrix metalloproteinase-9 (MMP-9) and inhibitor of metalloproteinase-1 relationship. Methods: One of the two methods of voluntary abortion or induced abortion were included in the first trimester menopause within 8 weeks of menopause. The patients were divided into induced abortion group, incomplete abortion group and complete abortion group. The decidua tissues were collected and fixed in 10% formalin and embedded in paraffin. The expression of MMP-3, MMP-9 and TIMP-1 were detected by immunohistochemical method and quantified by image analyzer. Results: MMP-3, MMP-9 and TIMP-1 mainly distributed in the cytoplasm of uterine decidual epithelial cells, glandular epithelium and stromal cells. The expression of MMP-3 and MMP-9 was significantly increased in patients with incomplete drug bleed (P <0.01), and the expression of TIMP-1 was significantly decreased (P <0.01). Conclusion: The effect of mifepristone on the expression of MMP-3, MMP-9 and TIMP-1 in decidual epithelial cells, glandular epithelial cells and stromal cells is decreased, and the imbalance between the two is caused by mifepristone, which leads to the degradation of extracellular matrix and vascular fragility Increase, bleeding occurs.