摘要目的 探讨子宫主韧带中弹性蛋白、赖氨酰氧化酶和弹性蛋白酶抑制剂基因表达变化与盆腔器官脱垂(POP)发生、发展的关系.方法 选择因子宫脱垂而行子宫全切除术的患者60例(POP组),其中绝经前27例,绝经后33例;选择同期因妇科良性疾病、无压力性尿失禁或POP而行子宫全切除术的患者60例为对照组,其中绝经前42例,绝经后18例.于手术中取子宫主韧带,采用RT-PCR技术检测弹性蛋白、赖氨酰氧化酶和弹性蛋白酶抑制剂mRNA的表达,免疫组化蛋白印迹法检测3种基因的蛋白表达.结果 (1)弹性蛋白mRNA及蛋白表达:POP组患者绝经前、后子宫主韧带弹性蛋白mRNA的表达分别为0.42±0.22、0.26±0.20,子宫主韧带弹性蛋白的蛋白表达分别为0.44±0.32、0.20±0.19;对照组患者绝经前、后子宫主韧带弹性蛋白mRNA的表达分别为0.79±0.30、0.63±0.23,子宫主韧带弹性蛋白的蛋白表达分别为0.89±0.27、0.78±0.25,两组绝经前及绝经后患者子宫主韧带弹性蛋白mRNA及蛋白表达分别比较,差异均有统计学意义(P＜0.05).(2)赖氨酰氧化酶mRNA及蛋白表达:POP组患者绝经前、后赖氨酰氧化酶mRI~A的表达分别为0.37±0.18、0.20±0.14,赖氨酰氧化酶的蛋白表达分别为0.45±0.27、0.26±0.21,对照组患者绝经前、后子宫主韧带赖氨酰氧化酶mRNA表达分别为0.65±0.22、0.53±0.20,子宫主韧带赖氨酰氧化酶的蛋白表达分别为0.85±0.39、0.69±0.31,两组绝经前及绝经后患者子宫主韧带赖氨酰氧化酶mRNA及蛋白表达分别比较,差异均有统计学意义(P＜0.05).POP组患者绝经后子宫主韧带弹性蛋白、赖氨酰氧化酶mRNA及蛋白表达均明显低于绝经前患者(P＜0.05).(3)弹性蛋白酶抑制剂mRNA及蛋白表达:POP组患者绝经前、后子宫主韧带弹性蛋白酶抑制剂mRNA表达分别为1.33±0.35、1.47±0.37,子宫主韧带弹性蛋白酶抑制剂的蛋白表达分别为0.85±0.30、0.76±0.35,对照组患者绝经前、后子宫主韧带弹性蛋白酶抑制剂mRNA表达分别为0.62±0.25、0.55±0.24,子宫主韧带弹性蛋白酶抑制剂的蛋白表达分别为0.21±0.15、0.29±0.22,两组绝经前及绝经后患者子宫主韧带弹性蛋白酶抑制剂mRNA及蛋白表达分别比较,差异均有统计学意义(P＜0.05);POP组患者绝经前、后弹性蛋白酶抑制剂mRNA及蛋白表达比较,差异无统计学意义(P＞0.05).POP患者子宫主韧带弹性蛋白与赖氨酰氧化酶mRNA及蛋白表达量呈明显的直线正相关关系(r=0.9959、0.9708,P＜0.05),而弹性蛋白与弹性蛋白酶抑制剂mRNA及蛋白表达量无直线相关性(r=-0.0402、-0.0365,P＞0.05).结论 POP患者子宫主韧带弹性蛋白、赖氨酰氧化酶表达下调及弹性蛋白酶抑制剂表达上调,可能与POP发生有关.

abstractsObjective To investigate expression of elastin,lysyl oxidase (LOX)and elafin in cardinal ligament of women with pelvic organ prolapse(POP) so as to determine their contributions to POP.Methods The cardinal ligament samples were obtained from 60 POP subjects and 60 non-POP control women undergoing hysterectomy.RT-PCR was used to verify the mRNA level of elastin,LOX and elafin.The protein concentration of the three genes was determined by western blotting technique,electrophoretic separation and quantification.Results The premenopansal and postmenopausal POP groups demonstrated significantly decreased expressions of elastin in cardinal ligament both in mRNA and protein levels than control group (mRNA 0.42±0.22,0.26±0.20 versus 0.79±0.30,0.63±0.23 ; protein 0.44±0.32,0.20±0.19 versus 0.89±0.27,0.78±0.25; P＜0.05).There was an identical tendency in the expression of LOX (mRNA 0.37±0.18,0.20±0.14 versus 0.65±0.22,0.53±0.20; protein 0.45±0.27,0.26±0.21 versus 0.85±0.39,0.69±0.31 ; P＜0.05).In POP group,the mRNA and protein levels of elastin and LOX in postmenopansal patients were significantly lower than premenopansal patients (P＜0.05).Inversely,POP group demonstrated an increased expression of elafin in cardinal ligament both in mRNA and protein levels than corresponding control group (mRNA 1.33±0.35,1.47±0.37 versus 0.62±0.25,0.55±0.24; protein 0.85±0.30,0.76±0.35 versus 0.21±0.15,0.29±0.22; P＜0.05). There was no significant difference in the expression of elafin between premenopansal and postmenopausal POP groups either in mRNA or protein levels(P＞0.05).There was a positive correlation between elastin and LOX both in mRNA and protein levels in POP group(r=0.9959,0.9708; P＜0.05),but there was no correlation between elastin and elafin(r=-0.0402,-0.0365;P＞0.05).Conclusions The results suggest that the decreased expression of elastin and LOX and the increased expression of elafin in the cardinal ligaments may contribute to POP.