非孕妇女口服米非司酮软化宫颈的作用及其机制探讨  

The effect of mifepristone on cervical softening of nonpregnant women and its mechanism

作　　者：沈奕[1] 原玮[1] 曹树军[1] 孙玮玮[2] 祝亚平[3] 

机构地区：[1]上海交通大学附属第一人民医院松江分院妇产科,上海201600 [2]上海交通大学附属第一人民医院松江分院病理科,上海201600 [3]上海交通大学附属第一人民医院妇产科,上海200080

出　　处：《药学服务与研究》2010年第3期190-193,共4页Pharmaceutical Care and Research

摘　　要：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基质金属蛋白酶-9(MMP-9)、MMP-2及组织金属蛋白酶抑制剂-1(TIMP-1)在宫颈组织中的表达,探讨米非司酮促进非孕妇女宫颈成熟的作用及其相关机制。方法:(1)90例需要行诊断性刮宫术的非孕妇女随机分为对照组(A1组)、米非司酮组(B1组)及米索前列醇组(C1组)。米非司酮组于第1天和第2天分别口服米非司酮25mg,tid;米索前列醇组于行诊断性刮宫术前2h口服米索前列醇400μg。所有研究对象均用扩宫棒测定两次宫颈非用力最大扩张度:行诊断性刮宫术前48h,及即将手术前。观察3组研究对象两次宫颈非用力最大扩张度的变化。(2)A1、B1、C1组行诊断性刮宫术前取部分宫颈组织作为标本,分别为B2、C2、D2组。取17例因子宫肌瘤行全子宫切除病人的部分宫颈组织作阴性对照组(A2组)。显微镜下观察4组宫颈组织的形态学变化,采用免疫组化Elivison二步法检测这4组宫颈组织的MMP-9、MMP-2及TIMP-1的表达。结果:C2组用药前后宫颈扩张的差异与A2、B2组相比有统计学意义(P<0.001),与D2组相比差异没有统计学意义。C2组和D2组显微镜下显示组织水肿,结构疏松,间隙增宽,毛细血管扩张,毛细血管内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(P<0.05),而与D2组无明显差异。MMP-2、TIMP-1在4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软化的作用,MMP-9参与了此过程,而此药对MMP-2及TIMP-1的表达没有影响,米非司酮促宫颈软化的机制可能与它的抗孕作用相关。Objective：To observe the effect of mifepristone on the cervical softening of nonpregnant women and explore the mechanism by determination of the expression of matrix metalloproteinase-9（MMP-9）,MMP-2 and tissue inhibitor of matrix-metalloproteinase 1（TIMP-1） in the cervix tissue.Methods：（1）Ninety nonpregnant women who would receive diagnostic curettage were randomly divided into control group（A1）,mifepristone group（B1） and misoprostol group（C1）.The patients in B1 group took mifepristone 25 mg,tid,on the first and second days.The patients in C1 group took misoprostol 400 μg at 2 h before diagnostic curettage.The extent of cervix dilatation of the patients in 3 groups were determined at 48 h before the diagnostic curettage and immediately before the curettage.The differences of cervix dilatation of the 3 groups were compared.（2） Cervical tissues taken from the patients in A1,B1 and C1 groups before diagnostic curettage were assigned to B2 （n=15）,C2（n=23） and D2（n=18） groups,respectively.Cervical tissues taken from 17 patients undergoing total hysterectomy because of hysteromyoma constituted A2 group.The histomorphology of cervical tissues of the 4 groups were observed under microscope and the expression of MMP-9,MMP-2 and TIMP-1 in cervical tissues was determined by immunohistochemical method.Results：The differences of extent of cervix dilatation before and after the administration of drugs in C2 group were statistically significant compared with those of A2 and B2 groups（P0.001）,and the difference was not significant compared with that of D2 group.These cervix tissues of C2 and D2 groups showed the changes of edema,the distance between cells was wide and capillaries were dilated.In and around the capillaries,inflammatory cell infiltration could be seen.These changes were not observed in A2 group.The changes of edema and inflammatory cell infiltration in tissue were not obvious in B2 group.Compared with A2 and B2 groups,the expression of MMP-9 was increased in C2 gr

关 键 词：米非司酮 宫颈软化 妇女 非孕妇 基质金属蛋白酶 金属蛋白酶1组织抑制剂 

分 类 号：R984[医药卫生—药品] R969[医药卫生—药学]