基质金属蛋白酶及其抑制物在胎盘粘连发生中的作用.docVIP

基质金属蛋白酶及其抑制物在胎盘粘连发生中的作用 作者：柯豫,陆继红,马琼燕,朱红 单位：上海市浦东新区公利医院妇产科 【摘要】 目的 探讨基质金属蛋白酶(MMP)-9、MMP-2及基质金属蛋白酶抑制物(TIMP)-1、TIMP-2在胎盘粘连发生中的作用。方法 选择孕足月胎盘粘连产妇23例作为胎盘粘连组，其中9例分娩后即刻取蜕膜组织作为蜕膜粘连组；正常足月分娩产妇28例作为正常胎盘组，其中11例分娩后即刻取蜕膜组织作为正常蜕膜组。采用免疫组化PicTureTM二步法分别检测4组产妇MMP-9、MMP-2、TIMP-1、TIMP-2 蛋白的表达水平；免疫组化结果采用彩色图像分析软件定量分析。结果 ①胎盘粘连组与正常胎盘组相比，MMP-9蛋白表达水平明显高于正常胎盘组，TIMP-1蛋白表达水平低于正常胎盘组，差异有统计学意义(PMMP-9lt;0.05，PTIMP-1lt;0.05)。② 蜕膜粘连组较之正常蜕膜组相比，MMP-9蛋白表达的水平无统计学差异(P＞0.05)，TIMP-1蛋白表达水平明显降低，差异有统计学意义(Plt;0.05)。③胎盘粘连组与正常胎盘组相比，MMP-2蛋白表达水平明显升高，差异有统计学意义(PMMP-2lt;0.05) ，TIMP-2蛋白表达无统计学差异（PTIMP-2＞0.05）。④蜕膜粘连组较之正常蜕膜组相比，MMP-2表达水平无统计学差异（P＞0.05），TIMP-2表达水平明显降低，差异有统计学意义（Plt;0.05）。结论 母胎界面MMP和TIMP比例失衡导致子宫细胞外基质降解增加造成胎盘粘连。在胎盘界面以MMPs升高为主要机制，而在蜕膜界面则以TIMPs降低不能有效抑制MMPs的降解作用而导致胎盘粘连。 【关键词】 胎盘：侵入性；基质金属蛋白酶 　　Involvement of Matrix Metalloproteinase-2, -9, and Tissue Inhibitors of Metalloproteinase-1,2 in occurrence of the Placenta Accreta　　Ke yu, Lu Ji hong, Ma Qong yang, et al　　Shanghai Pudong New Area GongLi hospital Obstetrics and Gynecology, Shanghai ，200135，China 　　Abstract Objective To study the role of matrix metalloproteinase-2, -9 (MMP-2, -9) and tissue inhibitors of metalloproteinase-1, -2 (TIMP-1, -2) in the pathogenesis of placenta accreta. Methods The full-term pregnant women with placentaaccreta of 23 were recruited, Among them, 9 patients was performed immediately uterine curettage for decidual tissue collection after delivery. Another 28 normal pregnant women who delivered in the same period were recruited as control, among them 11 patients was performed immediately uterine curettage for decidual tissue collection after delivery. The protein expression of MMP-9, MMP-2, TIMP-1 and TIMP-2 were investigated by immunohistochemistry (PicTureTM two-step method). The immunohistological results were analyzed quantitatively by color imaging analysis software. Results ① It was found that MMP-9 protein expression in the placenta accreta were significantly higher than that of the normal placental control (Plt;0.05), but the