摘要
目的本试验通过比较压力性尿失禁(SUI)、盆腔器官脱垂(POP)患者及对照组的阴道前后壁蛋白基因产物9.5(PGP9.5)及血管活性肠肽(VIP)的分布变化来寻找盆底失神经支配的进一步证据,分析VIP与SUI及POP发生的关系。方法40例患者分为SUI组(13例)、POP组(14例)和无症状对照组(13例),取阴道前后壁黏膜制成冰冻切片,用半定量免疫组化的方法对阴道前后壁PGP9.5、VIP进行研究。结果(1)阴道壁中PGP9.5表达强度大于VIP。(2)对照组中PGP9.5(P=0.016)和VIP(P=0.033)在阴道前壁的表达显著高于后壁,而在其他组则无显著差异。(3)SUI组与对照组相比,阴道前壁PGP9.5的表达显著降低(P=0.016)。(4)SUI组和对照组中阴道前后壁PGP9.5与年龄呈负相关,SUI组阴道前壁PGP9.5表达还与腹部漏尿点压力(ALPP)呈正相关(r=0.590,P=0.034),POP组中VIP在前、后壁的表达与年龄(r=-0.837,r=-0.560)、绝经年限(r=-0.841,r=-0.594)呈负相关。(5)各组的PGP9.5和VIP的表达均与体重指数(BMI)无相关性。结论阴道壁的神经损伤主要发生在前壁,这不仅与SUI的发生有关,也是SUI与POP的病理生理学差异。阴道黏膜中VIP的阳性率较低,其分布与血管的关系密切,在POP组与年龄和绝经年限相关,提示绝经后生殖道血供减少,盆底组织薄弱,易使POP病情进展,但是否发生SUI,还有其他因素参与。
Objective：The aim of our study is to compare the distribution of vasoactive intestinal peptide （VIP） and protein gene product 9.5 （PGP 9.5） in the vaginal wall of women with different conditions, to provide further evidence of denervation in pelvic floor and analyze the relationship between neuropeptides and etiology of pelvic organ prolapse （POP） and stress urinary incontinence （SUI）.
Methods： Anterior and posterior vaginal wall samples were obtained from 40 patients （13 with SUI, 14 with POP and 13 asymptomatic controls）. Samples were examined with histochemical techniques. Semiquantitative immunohistochemical study was performed to investigate systemically the distribution of nerve terminals in anterior and posterior vaginal wall.
Results： 1. The expression of PGP9.5 in vaginal wall was significantly higher than that of VIP. 2. In control group, the expression of PGP9.5 （P=0. 016）and VIP（P=0. 033） in the anterior vaginal wall was significantly higher than that in posterior wall. 3. The expression of PGP9.5 in anterior vaginal wall in SUI group was significantly lower than that in control group （P=0. 016）. 4. In SUI and control group,the expression of PGP9. 5 was negatively correlated with age; the expression of PGP9.5 in the anterior vaginal wall in SUI group was positively correlated with abdominal leak-point pressure （r=0. 590, P= 0. 034）. In POP group, the expression of VIP in the anterior and posterior vaginal wall was negatively correlated with age （r=-0. 837, r=-0. 560） and menopause of duration （r=-0. 841, r=-0. 594）.
Conclusions. 1. Partial denervation mainly in the anterior vaginal wall contributed to SUI, and this was the pathophysiologic difference between SUI and POP. 2. The VIP expression in the vaginal wall was very low, with its distribution related to blood vessels. Its negative correlation with age and menopausal duration in POP group indicated that reduction of blood supply in genital tract resulted in the pelvic floor relaxing and POP p
出处
《生殖医学杂志》
CAS
2008年第6期444-448,共5页
Journal of Reproductive Medicine
关键词
压力性尿失禁
阴道壁
蛋白基因产物9.5
血管活性肠肽
Stress urinary incontinence
Vaginal wall
Protein gene product 9. 5
Vasoactive intestinal peptide
