水中待产产妇盆底组织MMP-1、TIMP-1的表达及临床意义  

Influence Exerted by Laboring in Water on Positive Rate of MMP-1 and TIMP-1 in Pelvic Floor Tissue and Its Clinical Significance

作　　者：刘颖琳[1] 谭玉清[2] 丁红[1] 郭仲杰[1] 黄修治[1] 彭静[1] 张建平[1] 

机构地区：[1]中山大学孙逸仙纪念医院妇产科,广东广州510120 [2]江门市妇幼保健院,广东江门529000

出　　处：《中山大学学报（医学科学版）》2013年第4期568-573,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划社会发展项目(2010B080701011)

摘　　要：【目的】通过检测水中待产产妇盆底组织中基质金属蛋白酶-1(MMP-1)和基质金属蛋白酶抑制物-1(TIMP-1)的表达,探讨水中待产对盆底组织是否具有保护作用。【方法】2009年6月至2011年2月,收集在中山大学孙逸仙纪念医院自愿选择水中待产的产妇38例为试验组。同期、一般情况及产科条件相近、选择传统阴道试产的产妇70例为对照组。调查两组阴道分娩产妇孕期、产后42天压力性尿失禁症状(SUI)和盆腔器官脱垂(POP)情况。试验组和对照组最终分别有33、47例成功阴道分娩,于第三产程后取会阴侧切伤口底部组织,并进行石蜡包埋切片,用免疫组化SP染色法分别检测组织中MMP-1、TIMP-1的表达。【结果】1.两组孕期出现SUI症状的发生率差异无统计学意义(18.18%vs 31.91%,P=0.17),试验组产后42 d伴有SUI症状的发生率(2/33,6.06%)显著低于对照组(11/47,23.40%)(P=0.04)。两组阴道分娩产妇产后42 d POP发生率相近(24.24%vs 25.53%,P>0.05)。试验组盆底组织MMP-1阳性率(3/33,9.09%)显著低于对照组(32/47,68.09%)(P<0.001),试验组TIMP-1阳性率低于对照组,但差异没有统计学意义(12.12%vs 17.02%,P=0.546)。盆底组织MMP-1阳性表达与产后42 d SUI症状发生有关(OR=22.96,95%CI 2.81-187.73),盆底组织MMP-1阳性与产后42 d POP发生有关(OR=5.56,95%CI 1.88-16.42)。未发现TIMP-1与产后42 d SUI及POP的确切关系,对应OR(95%CI)分别为2.083(0.46-9.38)及3.02(0.83-11.06)。【结论】水中待产产妇盆底组织中MMP-1的阳性表达较低,可能与水中待产对盆底组织具有保护作用有关。[Objective] To discuss the influence posed by laboring in water on the positive rate of matrix metalloproteinase-1 （MMP-1） and tissue inhibitor of metalloproteinase-1 （TIMP-1） in pelvic floor tissue. [Methods] The experimental objects included the healthy primipara hospitalized in Obstetrical Department of the Sun Yat-sen Memorial Hospital of Sun Yat-sen University during June 2009 and February 2011 featured by single fetus, cephalic presentation and term pregnancy. Of these chosen lying-in women, 38 who volunteered to accept laboring in water composed the study group. Others chose traditional vaginal delivery with similar pregnant period, general condition and obstetrical condition composed the control group. The tissue was obtained in the incision of lateral episiotomy after the third stage of labor and were carried out in paraffin-embedded. And then used the antibody of MMP-1 and TIMP-1 to process the tissue before making slides. We recorded the positive rate of the two indexes after observing the slides by microscope ; surveyed the happening of stress urinary incontinence （SUI） and pelvic organ prolapse （POP） of both groups during pregnancy and 42 days after labor. [ Results ] （ 1 ）The incidence of SUI in two groups of vaginal delivery had no statistically significant difference （18.18% vs 31.91%, P = 0.17）, study group accompanied by SUI symptoms at postpartum 42 days （2/33,6.06%） was lower than control group （11/47, 23.40% ） （P = 0.04）. To the vaginal delivery cases in the two groups, the incidence of POP 42 days after delivery was not statistically significant （24.24% vs 25.53% ,P 〉 0.05）. （2）The positive rate of MMP-1 in study group （3/33, 9.09% ） was lower than control group （32/47, 68.09% ） （P 〈 0.05）, the positive rate of TIMP-1 in study group was lower than control group, but not statistically significant （12.12% vs 17.02%, P = 0.546）. （3） Samples with positive MMP-1 was related to the occurrence of SUI 42 days after delivery （OR =

关 键 词：水中待产 基质金属蛋白酶-1 压力性尿失禁 

分 类 号：R714.46[医药卫生—妇产科学]