| Objective: This study of mifepristone from terminating the mechanism in early pregnancy, researching the influence of mifepristone on the ultrastructure and the expression of MMP-2,MMP-9,TIMP-1 of human decidua and villus in early pregnancy by swallowing mifepristone 150 mg at one time respectively affect on 12h,24h,48h, to compare whether different treatment time of mifepristone existing distinction of decidua and villus in early pregnancy, so that a theoretical basis for shortening the time and simplifying the schedule of clinical medical abortion might be provided.Methods: 80 cases pregnant women within 49 days, were randomly divided into four groups: control group, medication 12 h group, 24 h group, 48 h group, and 20 cases each of .The pregnant women in the control group were terminated of pregnancy by conventional suction. The medication groups swallowed mifepristone 150 mg at one time, 12h,24h and 48h later, suction was operated, and the decidua and villus were taken as soon as possible. Specimens were observed by light microscope and transmission electron microscopy. The expression of MMP-2,MMP-9,TIMP-1 were detected in decidua and villus by immunohistochemistry(SP). All data were analysed by SPSS(13.0) for Windows.Results:1 Ultrastructural resultsOn the role of mifepristone, the variance of decidua and villus on the ultrastructure mainly appearance that large decidual cell shrinkage, rough endoplasm reticulum and mitochondria swell;and electron dense particles in the decidual granular cells decrease or disappear; villous syneytiotrophoblast which have active function show various degrees of degenerative changes,and langhans cell only change slightly. As for the damaged degree of decidua and villus on the ultrastructure, the treated group exceed the control group remarkably (P <0.05), and among the treated groups there are no significant difference (P> 0.05).2 Immunohistochemical results: All of MMP-2,MMP-9,TIMP-1 express strongly in the cytoplasm of decidual cells,glandular epithelial cells,cavitary epithelial cells,cytotrophoblast and syncytiotrophoblast cells,capillary endothelial cells of each group.In decidua, the positive goal of the average optical density values of MMP-2 are respectively 0.1555±0.0079,0.1952±0.0072,0.1958±0.0010,0.1967±0.0069 in the control group, taking mifepristone 12 h group, 24 h group, 48 h group, and they are respectively 0.1555±0.0083,0.2033±0.0059, 0.2076±0.0092,0.2079±0.0088 in villus , the treated groups is higher than the control group(P<0.05), and among the treated groups there are no statistical significance (P> 0.05).The positive goal of the average optical density values of MMP-9 in decidua are respectively 0.1656±0.0056,0.2032±0.0067,0.2051±0.0070,0.2084±0.0078 in the four groups, and they are respectively 0.1617±0.0047,0.2025±0.0074,0.2039±0.0095,0.2099±0.0113 in villus , the treated groups is higher than the control group(P<0.05), and among the treated groups there are no statistical significance (P> 0.05).The positive goal of the average optical density values of TIMP-1 in decidua are respectively 0.1679±0.0127,0.1382±0.0071,0.1402±0.0102,0.1355±0.0077 in the four groups, and they are respectively 0.1548±0.0098,0.1349±0.0106,0.1349±0.0093,0.1273±0.0095 in villus , the treated groups is higher than the control group(P<0.05), and among the treated groups there are no statistical significance (P> 0.05).The proportionality of MMP-9/TIMP-1 in the villus and decidua of the taking mifepristone groups are higher than the control group(P<0.05). The expression of MMP-9/TIMP-1 in the decidua of the four groups are respectively 0.9914±0.0837,1.4493±0.1369,1.4950±0.1352,1.5182±0.0884, and in the villus are respectively 0.9937±0.0554,1.5216±0.1066,1.5138±0.1405,1.5994±0.0842, and among the treated groups there are no statistical significance (P> 0.05).Conclusion:1 This study explaine that mifepristone cause the decidual cells protein synthesis blocked, granule cells released relaxin, reticular fiber of matrix dissolved, endomembrane exfoliated, trophoblast cells lost support, blood supply inadequated, triggered abortion.2 The expression of MMP-2,MMP-9 in decidua and villus of the taking mifepristone groups are all higher than the control group, and the expression of TIMP-1 is lower than the control group, the proportionality of MMP-9/TIMP-1 are higher significantly, all of which explain MMP-2,MMP-9 and TIMP-1 play an important role in the process of medical abortion in early pregnancy,MMP-9 and TIMP-1 for the balance of the maintenance of normal early pregnancy play an important role.3 This study research the influence of mifepristone on the ultrastructure and the expression of MMP-2,MMP-9,TIMP-1 of human decidua and villus in early pregnancy, reveal that swallowing mifepristone 150 mg at one time 12h or 24h, the inhibitory action of decidua and villus is as similar as 48h, if misoprostol used at this time, the effect of abortion might be comparable in theory with the traditional treatment for the standard programme of 48 h interval, so that the interval of the two drugs for medical abortion might be shortened to 12 h. |
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