妊娠期发生盆底功能障碍的影响因素分析  

Analysis of the Factors Influenced the Dysfunction of Pelvic Floor in Primipara

作　　者：姜丽[1] 王霞红[1] 吴氢凯[2] 奚杰[1] 曹云桂[1] 张青[1] 朱梅娟[1] 姚静[1] 

机构地区：[1]上海市嘉定区妇幼保健院,201300 [2]上海交通大学附属第六人民医院妇产科

出　　处：《国际妇产科学杂志》2014年第2期204-206,I0002,共4页Journal of International Obstetrics and Gynecology

基　　金：上海嘉定区卫生局青年课题(QNKYJJ 2011-12-04)

摘　　要：目的:探讨阴道壁组织中弹力纤维、胶原纤维、fibulin-5和转化生长因子β(TGF-β)与初产妇妊娠晚期盆底功能障碍的关系。方法:选取阴道分娩并行会阴侧切的初产妇40例,无妊娠期高血压、妊娠期糖尿病、胎儿生长受限(FGR)和巨大儿。将既无阴道前壁脱垂也无压力性尿失禁(SUI)初产妇设为对照组(20例),将阴道前壁脱垂(包括Ⅰ度和Ⅱ度脱垂的)合并SUI初产妇设为病例组(20例)。所有研究对象阴道分娩行会阴侧切时取少许阴道壁组织行Masson染色检测弹力纤维和胶原纤维的差异,免疫组织化学检测fibulin-5和TGF-β的表达情况,免疫组化结果使用Image-Pro Plus软件分析。结果:2组患者TGF-β蛋白表达量差异无统计学意义(t=1.670,P=0.098),对照组fibulin-5蛋白表达量高于病例组(t=3.062,P=0.005)。病例组胶原纤维和弹力纤维排列稀疏、紊乱,且纤维之间出现断裂,对照组纤维排列致密,形态完整。结论:妊娠期盆底弹力纤维和胶原纤维的异常以及fibulin-5表达减少可能与妊娠期盆底功能障碍发病有关。Objective：To explore the relationship between the dysfunction of pelvic floor in primipara and the expression of elastin、collagen、fibulin-5 and TGF-βin vaginal wall. Methods：The subjects composed of primipara delivered in Maternal and Child Health Care Center of Jiading District,without complications of hypertention,GDM,FGR and fetal macrosomia,aged 20-30 years. The study group,women with SUI andⅠorⅡdegree prolapse of anterior vaginal wall by POP-Q and the control group,women without SUI or prolapse of vaginal wall,were investigated. Vaginal wall specimens were obtained during the vaginal delivery after lateral episiotomy. Tissues were detect by Masson stainning to compare the difference of elastin and collagen while expression level of fibulin-5 and TGF-βby immunohistochemistry. Results were analysed by Image-Pro Plus software and Student′s t-test as statistical method. Results：Expression of fibulin-5 were higher in the control group than in the study group （t=3.062,P=0.005）,while TGF-βhad no statistical difference between them （t=1.670,P=0.098）. Elastin and collagen were abnormal between the two groups by Masson staining,regular,intact in the control group while disorder,fracture in study group. Conclusions：The dysfunction of pelvic floor in pregnancy period may be caused by the decreased expression of elastin and fibulin-5 which is the crosslink factor of elastin.

关 键 词：尿失禁 压力性 纤维胶原类 转化生长因子Β 盆底功能障碍 盆腔器官脱垂 

分 类 号：R714.259[医药卫生—妇产科学]