【作者】 彭爱新；

【导师】 刘瑞芬；

【作者基本信息】 山东中医药大学 ， 中医妇科学， 2008， 博士

【摘要】 目的:从细胞凋亡角度探讨宫清颗粒防治药流后出血的机理。方法:将180例药物流产患者随机分为宫清颗粒组60例(药流第一天即加服宫清颗粒)、茜芷胶囊组60例(药流第一天即加服茜芷胶囊)及药流对照组60例(单纯口服米非司酮与米索前列醇),观察用药后的临床疗效。同时设人工流产组60例。在观察疗效的同时,获取各组早孕绒毛、蜕膜组织,运用电镜技术及免疫组化、原位杂交、琼脂糖凝胶电泳法等先进方法,从形态学、分子及基因水平观察取材组织的电镜形态学改变、PR(孕激素受体)、EGF(表皮生长因子)、EGFR(表皮生长因子受体)、凋亡执行蛋白酶casepase-3、caspase-8及其mRNA的表达情况及其各指标间相互关系。结果:宫清颗粒组孕囊排出时间优于茜芷胶囊组和药流对照组,差异均有非常显著性(P<0.01);宫清颗粒组药流后阴道出血量、少于茜芷胶囊组,差异均具有显著性(P<0.05);宫清颗粒组药流后阴道出血量、出血时间少于药流对照组,差异均具有显著性(P<0.01或P<0.05)。绒毛、蜕膜电镜形态学观察表明,宫清颗粒组呈现明显凋亡表现;宫清颗粒组琼脂糖凝胶电泳出现明显DNA梯形条带;宫清颗粒组药流后绒毛PR、EGF、EGFR表达较其他三组明显降低,差异均具有显著性(P<0.05);宫清颗粒组药流后蜕膜PR、EGF、EGFR表达较其他三组明显降低,差异均具有非常显著性(P<0.01);宫清颗粒组药流后绒毛、蜕膜组织caspase-3、caspase-8及其mRNA表达较其他三组明显增加,差异均具有显著性(P<0.05)。结论:宫清颗粒能下调PR在绒毛和蜕膜组织的表达,促进绒毛滋养细胞和蜕膜组织变性、坏死及凋亡,使残留绒毛、蜕膜组织尽快排出体外而防治药物流产后出血;宫清颗粒能下调EGF、EGFR在绒毛和蜕膜组织的表达,抑制其促增生、分化的作用,诱导发生受体介质功能紊乱和抑制,促进绒毛滋养细胞和蜕膜组织变性、坏死及凋亡而防治药物流产后出血;宫清颗粒能上调casepase-3、caspase-8在绒毛和蜕膜组织的表达,通过细胞膜途径,促进滋养层细胞和蜕膜组织凋亡增加而防治药物流产后出血。且宫清颗粒的临床疗效和对药物流产后人早孕绒毛、蜕膜细胞凋亡相关指标的改善明显优于茜芷胶囊。更多还原

【Abstract】 Objective: To investigate the effects of Gongqing grain on the expressions of induced factor and regulating protein of the apoptosis in villi and decidua in hemorrhage after human early medical abortion .Method: 180 patients were divided into three groups randomly on their owns accord:the GongQing grain group (n=60,taking GongQing grain at the first day of the medical abortion),QianZhi capsule group(n=60,taking QianZhi capsule at the first day of the medical abortion), the medical abortion group(n=60,only taking mifepristone and misoprostol) ,and artificial abortion group(n=60)was set.Symptoms and signs of each group were observed before and after treatment.Meanwhile villi and deciduas of each group were collected. The experiment utilized electronic microscopic technique,and applied advanced methods of im-munohistochemica、insituhybridization and DNA agarose gel electrophoresis to observe the expressions of epidermal growth factor(EGF)、epedermal growth factor receptor(EGFR)、progesterone receptor(PR)、regulating protein (caspase-3、8)and the change of their mRNA in the villi and deciduas in early medical abortion.Results: There was significant difference between GongQing grain group with the QianZhi capsule group and the medical abortion group in the blastocyst discharged time, the period and the amount of lochia ( P<0.05/P<0.01). The electronic microscopic observed indicated distinct change of apoptosis in the GongQing grain group. The obvious DNA ladder was observed in the decidual tissue and chorionic villi in Gong Qing grain group.The level of PR、EGF and EGFR in the villi and deciduas decreased more significantly in the GongQing grain group than the other three groups(P<0.05/P<0.01). The level of caspase-3、8 and the changes of their mRNA increased more significantly in the GongQing grain group than the other three groups(P<0.05).Conclusion: It was speculated that GongQing grain resisted early pregnancy because it suppressed the expression of PR、EGF、EGFR,it improved the expression of caspase-3、8and their mRNA in chorionic villi and deciduas. These was its possible scheme that it could shorten the duration of vaginal bleeding after medical abortion.更多还原