米非司酮药物流产阴道出血原因探讨  

THE STUDY ON THE CAUSE OF VAGINAL BLEEDING AFTER THE EARLY ABORTION INDUCED BY MIFEPRISTONE

作　　者：宋淑芳[1] 宋静慧[1] 李国慧[1] 刘晓颖[1] 

机构地区：[1]内蒙古医学院附属医院妇产科,内蒙古呼和浩特010050

出　　处：《内蒙古医学院学报》2006年第3期181-184,共4页Acta Academiae Medicinae Neimongol

摘　　要：目的:探讨米非司酮药物流产阴道出血原因。方法:对30例米非司酮药物流产(米非司酮组)及30例正常早孕吸宫流产(正常对照组)的早孕绒毛及蜕膜组织应用流式细胞定性定量分析技术进行DNA分析,应用光镜对组织细胞形态学进行观察,并随机抽取6例米非司酮药物流产及2例人工吸宫流产的绒毛及蜕膜组织应用透射电镜进行细胞超微结构观察。结果:米非司酮组绒毛蜕膜细胞形态学显示凋亡改变,且绒毛形态学上的改变重于蜕膜。DNA直方图上均有亚二倍体峰(凋亡峰)出现,米非司酮组和对照组绒毛凋亡水平分别为9.38±1.84%、4.64±0.86%(P<0.01),蜕膜凋亡水平分别为7.64±1.81%、4.06±1.49%(P<0.01)。绒毛滋养细胞增殖指数分别为30.84±7.19%、31.02±5.82%(P>0.05),蜕膜增殖指数分别为23.87±2.50%、21.02±2.57%(P>0.05)。米非司酮组绒毛凋亡水平高于蜕膜,差异有显著性(P<0.05)。结论:米非司酮可诱导和促使早孕绒毛蜕膜组织发生细胞凋亡,且米非司酮对绒毛细胞凋亡的影响大于蜕膜,而蜕膜凋亡的低水平且不彻底性正是米非司酮药物流产不全及药流后阴道出血时间长的原因所在。Objective：To study the cause of vaginal bleeding after the early abortion induced by mifepristone. Methods：Random sampling the early pregnant chorionic villi and decidual ceils from 30 surgical aspiration（ control group） and 30 mifepristone induced abortion （mifepristone group） using flow cytometry （FCM） to analyse the content of DNA, using optical microscopy to study the change of morphology, random sampling 2 surgical aspiration and 6 mifepristone induced abortion by using electron microscopy were observed on their ultrastructure. Results： Chorionic villi and deeidual cells of mifepristone induced abortion showed apoptotic change of morphology, and the change of chorionic villi was higher than decidua, each of which had apoptotic peak in DNA histogram. The chorionic villi apoptotic level in mifepristone group and control group were 9.38 ± 1.84%, 4.64± 0.86% ,respectively（P 〈0.01 ） ,decidual apoptotic level were 7.64 ± 1.81%, 4.06 ± 1.49% ,respectively （P 〈0.01 ） ,proliferation index of chorionic villi cells were 30.84 ±7.19% ,31.02 ±5.82% ,respectively （ P 〉 0.05 ） , proliferation index of decidual cells were 23.87 ± 2.50% ,21.02 ± 2.57 % , respectively（ P 〉 0.05 ）. Apoptotic level of chorionic villi was higher than decidua in mifepristone group（ P 〈 0.05）. Conclusion： Mifepristone induced and increased the apoptosis of the early pregnant chorionic villi and decidual cells, and the effect on villi was stronger than deciduas, the low level and incompletion of the decidual apoptosis were just the causes of vaginal bleeding after the early abortion induced by mifepristone.

关 键 词：米非司酮 绒毛膜绒毛 蜕膜 细胞凋亡 超微结构 

分 类 号：R719.31[医药卫生—妇产科学]