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目的探讨米非司酮药物流产后子宫出血与子宫内膜自然杀伤细胞(uNK)的关系。方法选取自愿终止妊娠的停经8周之内的早孕妇女,自愿选择药物流产或人工流产二种方法,分为负压吸引人工流产组、药流不完全组(出血组)、药流完全组。收集三组蜕膜组织进行甲醛固定,石蜡包埋,uNK细胞的表达采用免疫组化染色,图象分析仪定量分析。结果米非司酮药流不完全出血区uNK细胞的数量多于药流不完全非出血区、药流完全组及人流组,差异具有统计学意义(P<0.05)。药流完全组uNK细胞的数量多于人流组,二者间差异有统计学意义(P<0.01)。结论米非司酮的作用可以使uNK细胞数量异常增多,使子宫局部微环境发生改变,导致异常血管生成,孕囊与蜕膜剥离不全,从而引起出血。
Objective To investigate the relationship between uterine bleeding and endometrial natural killer cells (uNK) after mifepristone abortion. Methods Two methods of spontaneous abortion and voluntary abortion were included in the early pregnant women within 8 weeks of menopause who voluntarily terminated pregnancy. They were divided into negative abortion induced abortion group, incomplete abortion group (bleeding group) and complete abortion group. Three groups of decidual tissue were collected for formaldehyde fixation and paraffin embedded, and the expression of uNK cells was analyzed by immunohistochemical staining and image analyzer. Results The number of uNK cells in the incomplete hemorrhage area of mifepristone was more than that in incomplete drug non-hemorrhage area, complete drug flow and in abortion. The difference was statistically significant (P <0.05). The number of uNK cells in the complete abortion group was more than that in the abortion group, the difference was statistically significant (P <0.01). Conclusion The effect of mifepristone can increase the number of uNK cells abnormally, make the local microenvironment change, resulting in abnormal angiogenesis, pregnancy sac and decidual detachment, causing bleeding.