【作者】 高素芳；

【导师】 李奕；

【作者基本信息】 天津医科大学 ， 妇产科学， 2010， 硕士

【摘要】 目的：通过检测凋亡因子Fas和FasL的表达,探讨早孕绒毛在暴露于阴道超声照射后凋亡与修复的情况,并为临床早孕期阴道超声检查的安全性提供理论基础。方法：筛选2009.8-2009.10就诊于天津医科大学第二医院计划生育科自愿行人工流产的健康早孕妇女105例,按数字法随机分成三组：A组35例行常规腹部超声检查,探头频率为3.5MHz,24小时内行人工流产,取绒毛；B组35例行阴道超声检查10分钟,探头频率为7.5MHz,24小时内行人工流产,取绒毛；C组行阴道超声检查10分钟,探头频率为7.5MHz,第10天时行人工流产,取绒毛。1.三组病例超声检查后临床症状的统计学分析及比较。2.光镜下检测三组病例绒毛组织病理变化并进行统计学分析及比较。3.免疫组织化学法(S-P)检测病例组和对照组绒毛组织中Fas和FasL的表达并进行统计学分析及比较。结果：1.临床症状的统计超声检查后A组中无一例阴道出血；B组中有2例阴道出血；C组中有12例阴道出血,与A组和B组比较均有统计学意义(P<0.05)。2.早孕绒毛组织切片H-E染色检查光镜下三组病例中的早孕绒毛组织中均可见外层滋养细胞增生,其中B、C两组滋养细胞增生的例数均多于A组(P<0.0167),而且C组多与B组(P<0.0167)。3.免疫组织化学法检查在超声照射的A、B、C三组病例的早孕绒毛中,均有Fas和FasL蛋白表达,主要位于滋养细胞细胞膜和细胞质中,其阳性反应物为棕黄色颗粒。其中B组早孕绒毛滋养细胞凋亡蛋白Fas和FasL的表达明显高于A组(P＜0.0167)。C组早孕绒毛滋养细胞凋亡蛋白Fas和FasL的表达下降,与B组比较有显著差别(P<0.0167)。C组早孕绒毛滋养细胞凋亡蛋白Fas和FasL的表达与A组无明显差别(P>0.0167)。结论：1.在免疫组织化学中,凋亡蛋白Fas和FasL在腹部诊断超声和阴道超声照射后的早孕绒毛组织中均表达,主要在滋养细胞的细胞膜和细胞质中表达；探头频率为7.5 MHz的阴道超声持续照射10分钟,24小时内早孕绒毛滋养细胞中的Fas和FasL蛋白表达水平明显高于腹部诊断超声组,滋养细胞凋亡发生显著增加；探头频率为7.5 MHz的阴道超声持续照射10分钟,第10天时早孕绒毛滋养细胞中的Fas和FasL蛋白表达水平降低,且明显低于24小时内取绒毛组,与腹部诊断超声照射后的Fas和FasL蛋白表达水平相比无差别。2.超声照射后的早孕绒毛中存在细胞凋亡,但可以自我修复,即阴道超声照射后的早孕绒毛滋养细胞凋亡具有可复性。更多还原

【Abstract】 Objective:To detect the expression of Fas and FasL and analysis their changes on the apoptosis of human villi during first trimester pregnancy after exposuring tansviganal ultrasound, exploring the role of time playing in restoration of human villi during first trimester. And this paper show doctors a theory that it was feasible to take transvaginal ultrasound for first trimester pregnancy.Methods:105 health normal first trimester pregnant wemen who have visited NO.2 Clinical Hospital of Tianjin Medical University from August 2009 to October 2009 for artificial abortion to terminate their pregnancies were randomly divided into three groups:the numbers of the three groups were 35. The group A had 35 wemen exposed to transabdominal ultrasound; the group B exposed to a fixed beam from transvaginal ultrasound with a 7.5MHz transducer for 10 min, their villi were abtained in 24 hour after exposure; the group C also exposed to transvaginal ultrasound for 10 min, but their villi were abtained 10 days later after exposure. Observe the time from exposuring transvaginal ultrasound and style of the pathological changes in the human embryo villi. The typical structure changes in the chorionic villi were observed by microscope. The expression of Fas and FasL proteins were analyzed by immunohistochemistry.Results:1. Clinical symptoms Two people had the phenomenon of vaginal blood in the group B, and 12 in the group C, there was significantly difference between the group C and the group B(P<0.05). However, no one in group A.2. H-E performance The typical structure changes observed by microscope were that some trophoblasts were hyperplasia in three groups, there was significantly different in the group B and C (P<0.0167).3. P-S performance There were Fas and FasL protein in three groups. And they appeared in plasmalemma and cytoplasm of trophoblast, showing yellow. The expression of Fas and FasL in the group B were significantly higher than that of the group A (P<0.0167). The expression of Fas and FasL in the group C were significantly lower than that in group B(P<0.0167); The expression of Fas and FasL in the chorionic villi were no difference between the group C and the group A (P> 0.0167).Conclusion:1. The findings suggest that the higher expression of Fas and FasL protein took place in chorionic villi that was abtained 24 hours later after exposuring transvaginal ultrasound. The expression of Fas and FasL protein were lower in the chorionic villi that were abtained 10 days later after exposure transvaginal ultrasound.2. Apoptosis of trophoblasts appeared in human chorionic villi exposuring ultrasound, but these changes in human chorionic villi were restored by itself. It means that apoptosis of human chorionic villi will be restored after exposuring transvaginal ultrasound.更多还原