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目的 研究米非司酮配伍米索前列醇药物流产后蜕膜纤溶酶原激活剂及其抑制物 (PA、PAI)变化 ,探讨药物流产后异常子宫出血的机理。方法 4 5例早孕受试者随机平均分成 3组 :正常蜕膜组、米非司酮组和米非司酮米索前列醇药物流产组。应用逆转录 -聚合酶链反应 (RT PCR)技术、发色底物法和酶联免疫吸附试验 (ELISA)法观察 3组蜕膜组织型纤溶酶原激活剂 (tPA)和I型纤溶酶原激活剂抑制物 (PAI 1)mRNA及蛋白表达水平。结果 米非司酮米索组和米非司酮组tPA活性分别为 4 6 91± 2 0 74IU/mgprotein和 64 2 5± 35 81IU/mgprotein ,低于正常蜕膜组 (P <0 0 5) ;tPAmRNA水平以米非司酮米索组最高 ( 1 4 3± 0 39,P <0 0 5) ,而另 2组之间无差异 (P >0 0 5) ;PAI 1mRNA和蛋白水平 3组间均无差异 (P >0 0 5)。结论 米非司酮和米索前列醇经转录后途径降低人早孕子宫蜕膜tPA活性 ,可影响蜕膜剥落、血管再生、内膜复修而致药物流产后子宫出血时间过长。
Objective To study the changes of decidual plasminogen activator and its inhibitor (PA, PAI) after mifepristone and misoprostol medical abortion, and to explore the mechanism of abnormal uterine bleeding after medical abortion. Methods Forty five pregnant women were randomly divided into three groups: normal decidua group, mifepristone group and mifepristone misoprostol medical abortion group. The decidual tissue plasminogen activator (tPA) and type I fibrinolysis were observed by reverse transcription-polymerase chain reaction (RT PCR), chromogenic substrate assay and enzyme linked immunosorbent assay (ELISA) PAI 1 mRNA and protein expression levels. Results The tPA activities in the mifepristone and mifepristone groups were 4691 ± 2074IU / mgprotein and 6425 ± 3581IU / mgprotein, respectively, which were lower than those in the normal decidua group (P <0.05) ; the level of tPA mRNA was highest in the mifepristone-misoprostol group (143 ± 0 39, P <0 05), while there was no difference between the other two groups (P 0 05); PAI 1 mRNA and protein level in the 3 groups There was no difference between the two groups (P> 0.05). Conclusion Mifepristone and misoprostol can reduce the tPA activity of human uterine decidua after transfection and may affect the decidual exfoliation, vascular remodeling and endometrial repair resulting in prolonged uterine bleeding after medical abortion.