盆腔器官脱垂及尿失禁患者阴道壁的核心蛋白聚糖mRNA水平与胶原含量的关系  

Expression of Decorin and Collagen in the Anterior Vagina of Women With Pelvic Organ Prolapse and Stress Urinary Incontinence

作　　者：余燕 宋岩峰 

机构地区：[1]南京军区福州总院476临床部妇产科,福建福州350002 [2]南京军区福州总院妇产科

出　　处：《中华妇幼临床医学杂志（电子版）》2009年第4期12-15,共4页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：福建省重点科技项目(2005Y032)~~

摘　　要：目的探讨盆腔器官脱垂(pelvic organ prolapse,POP)及压力性尿失禁(stress urinary incontinence,SUI)患者阴道前壁组织中,核心蛋白聚糖(decorin,DCN)mRNA表达水平与阴道前壁组织Ⅰ型与Ⅲ型胶原含量变化的关系。方法将2007年3月至2008年3月南京军区福州总院476临床部妇产科收治的58例绝经前、后妇女,根据是否存在盆腔器官脱垂及压力性尿失禁分为POP组(n=21),POP+SUI组(n=20)和对照组(n=17)。应用酶联免疫吸附法(ELISA)检测两组妇女尿道周围结缔组织中Ⅰ型与Ⅲ型胶原含量;实时定量PCR法检测DCN mRNA表达水平。结果绝经前、后POP组和POP+SUI组患者阴道前壁组织胶原含量均下降,与对照组比较,差异有显著意义(P<0.01)。绝经前,POP组和POP+SUI组患者阴道前壁组织中,DCN mRNA表达水平增强,与对照组比较,差异有显著意义(P<0.05);绝经后,POP组患者decorin基因表达水平增强,但与对照组比较,差异无显著意义(P>0.05)。结论①绝经前、后,阴道壁组织的Ⅰ型与Ⅲ型胶原含量减少,胶原直径变细,支持力减弱,结缔组织弹性下降,从而引起盆腔器官脱垂或(和)压力性尿失禁;②盆腔器官脱垂及压力性尿失禁患者阴道组织蛋白聚糖类,可能通过影响盆底结缔组织胶原的代谢,影响盆底支持组织的力量和弹性性能,参与其发生、发展;③绝经后盆腔器官脱垂的发生机制复杂。Objective To explore quantity of type Ⅰ and Ⅲ collagen and decorin （DCN） mRNA expression in the upper portion of the anterior vaginal wall in patients with pelvic organ prolapse （POP） and stress urinary incontinence（SUI）. Methods Transvaginal biopsies were obtained from the anterior vaginal wall in 21 cases of POP（POP group）, 20 cases of POP＋SUI（POP＋SUI group） and 17 cases of normal women （control group）. The concentration of type Ⅰ and Ⅲ collagen were determined by ELISA method. RTQ-PCR was used to verify the level of DCN mRNA. Results The mean concentration extraceIlutar matrix metabolism was significantly reduced in patients of POP group and POP＋ SUI group, compared to control group（P〈0.01）. The DCN mRNA expression was significantly increased in pre-menopausal women of POP group and POP＋SUI group,compared to control group（P〈0.05）. In the post-menopausal women of POP group and POP＋ SUI group, the expression of decorin was increased, but there had no significant difference compared to that of control group（P〉0.05）. Conclusion A decrease in quantity of collagen type Ⅰ and Ⅲ in the connective tissue of anterior vaginal wail may compromise the tensile strength and flexibility, and result in an increase susceptibility to prolapse and stress urinary incontinence. To some extent, decorin might be involved in the pathogenesis of pelvic organ prolapse and stress urinary incontinence by influencing collagen metabolism in connective tissue of pelvic floor, and weaken their support strength and elastic properties. The pathogenesis of pelvic organ prolapse in post menopausal women is complicated.

关 键 词：盆腔器官脱垂 尿失禁 Ⅰ型与Ⅲ型胶原 蛋白聚糖类 

分 类 号：R694.54[医药卫生—泌尿科学] R711.2[医药卫生—外科学]