摘要
目的探讨盆腔器官脱垂（POP）患者耻骨宫颈筋膜中转化生长因子（TGF）-β1和结缔组织生长因子（CTGF）表达的作用。方法选取2009年5月至12月，30例因POP在本院行阴式子宫全切除术患者的耻骨宫颈筋膜组织纳入POP组，再按照盆腔器官垂定量（P0p-Q）将其分为POP—QⅡ°组（n=10）、POP—QⅢ°组（n=10）和POP—QIV。组（n=10）。选择20例同期在本院行阴式子宫全切除术的非POP患者的耻骨宫颈筋膜组织纳入对照组。应用免疫组化法和蛋白免疫印迹技术检测上述4组患者的耻骨宫颈筋膜组织中TGF-β1和CTGF的表达情况，分析二者之间及与POP及其分度的关系。POP组与对照组患者均已婚，绝经，无其他结缔组织疾病，无盆腔手术病史，无急、慢性盆腔炎病史，术前3个月内未服用雌激素类药物，术后病理学检查证实无雌激素相关性疾病。两组患者年龄、分娩次数、体重指数（BMD及其他与POP相关病史（慢性便秘、慢性咳嗽等）比较，差异无统计学意义（P〉0．05）（本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准）。结果①免疫组化检测结果显示：TGF-β1和CTGF呈阳性染色，主要定位于成纤维细胞的细胞质内。POP组TGF-β1和CTGF的阳性染色很弱，甚至缺失，阳性表达率分别为46．7％（14／30）和50．0％（15／30）。其中，POP—QⅡ°组阳性表达率分别为70．0％（7／10）和80．0％（8／10），POP—QⅢ°组分别为50．0％（5／10）和60．0％（6／10），POP—QⅣ°组分别为20．0％（2／10）和10．0％（1／10），均低于对照组[90．0％（18／20）和85．0％（17／20）]，且差异均有统计学意义（x2=27．242，x2=23．958；P〈0．05）。TGF-β1和CTGF表达与POP—Q分度呈负相关（r=-0．409，-0．572；P〈0．05）；而TGF-β1和CTGF两者之间的表达呈正相关性（r=0．401，P〈0．05）。②蛋白免疫印迹法检测对照组、POP—QⅡ°组、POP—QⅢ°组和POP—QⅣ°组耻骨宫颈筋膜组织中TGF-β1和CTGF的相对表达量分别为0．4344±0．097，0．2441±0．060，0．1844±0．041，0．1345±0．033和1．2732±0．180，0．2132±0．028，0．1045±0．023，0．0034±0．001。POP—QⅡ°～POP—QⅣ°组TGF1的表达量，均显著低于对照组，且差异均有统计学意义（P=0．000）；而POP-QⅡ°～POP—QⅣ°组之间除POP-QⅡ°组显著高于POp-QⅣ°组，差异均有统计学意义（P=0．001）外，POP—QⅡ°组与POP—QⅢ°。组及POP—QⅢ°组与POP—QⅣ°组比较，差异无统计学意义（P—o．068，0．126）。POP—QⅡ°～POp-QⅣ°组CTGF表达量均显著低于对照组，差异均有统计学意义（P=0．000）；POP—QⅡ°～POP—QⅣ°组间比较，差异亦有统计学意义（P=0．000）。结论POP患者耻骨宫颈筋膜组织中TGF-β1和CTGF表达下降，与POP的发病和临床分度有关。
Objective To investigate the role of transforming growth factor （TGF）-β1 and connective tissue growth factor （CTGF） in the development of pelvic organ prolapse （POP）. Methods From May 2009 to December 2009, 30 patients with POP underwent vaginal hysterectomy in Renmin Hospital of Wuhan University were enrolled in POP group,among whom according to pelvic organ prolapse quantitation （POP-Q） were divided into POP-QⅡ° group （n= 10）, POP-QⅢ° group （n= 10） and POP-Q Ⅳ° group （n= 10）. Meanwhile, pubocervical fascia samples of 20 patients were selected as controls treated by vaginal hysterectomy （control group, n= 20）. Immunohistochemical staining and Western blot were performed to detect the expression of TGF-β1 and CTGF. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Renmin Hospital of Wuhan University. Informed consent was obtained from all participants. Resnlts （1） By Immunohistochemical staining, TGF-β1 and CTGF were mainly expressed in the cytoplasm. The positive rate of TGF-β1 and CTGF expression in pubocervical fascia in POP group were 46.7%（14/30） and 50.0%（15/30） ,with 70.0%（7/10） and 80.0%（8/10） in POP-QⅡ° group, 50.0% （5/10） and 60.0%（6/10） inPOP-QⅢ° group, and 20.0%（2/10） and 10.0%（1/10） inPOP-QⅣ° group, respectively, which was significantly lower than those of control group [ （90.0 %, 18/20） and 85.0 % （17/20）] （x2 = 27. 242,x2 = 23. 958; P〈0.05）. The expression of TGF-β1 and CTGF were significantly negatively correlated with POP-Q grade （r = -0. 409, -0. 572; P〈 0. 05）. There were significantly positive correlation between the expression of TGF-β1 and CTGF （r=0. 401, P〈0.05）. （2） The expression of TGF-β1 and CTGF in POP-QⅡ°, POP-QⅢ° and POP-Q Ⅳ° groups were 0. 4344±0. 097, 0. 2441 ±0. 060, 0. 1844±0. 041, 0. 1345±0. 033 and 1. 2732±0. 180,0. 2132±0. 028,0. 1045±0. 023,0. 0034±0. 001, respectively, through Western blot. The expression of TGF-β1 in POP-QⅡ°, POP-QⅢ° and POP-Q Ⅳ° groups were all significantly lower than those of control group （P= 0. 000）. There were no significant differences in the expression of TGF-β1 for each other among POP groups （P=0. 068, 0. 126） excluding the comparison between POP-Q Ⅱ°, POP-Q Ⅲ° and POP-Q Ⅳ° groups （P = 0. 000）. The expression of connective tissue growth factor in POP-QⅡ° , POP-QⅢ° and POP-QⅣ° groups were all significantly lower than those of control group （P = 0. 000） and significant differences were also detected among POP-Q Ⅱ°, POP-QⅢ° and POP-QⅣ° groups （P=0. 000）. Conclusion TGF-β1 and CTGF expression is associated with POP, especially POP-Q grade.
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2011年第5期356-360,共5页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
基金
湖北省卫生厅面上项目(NX2011-5)~~
