雄激素受体在盆底器官脱垂性疾病阴道壁和主韧带中的表达

Expression of androgen receptor in the vaginal wall and cardinal ligament of patients with pelvic organ prolapse

目的了解雄激素及其受体与盆底功能障碍性疾病的关系。方法对象为盆底器官脱垂性疾病行子宫切除术患者38例和非盆底器官脱垂性疾病行子宫切除术患者（作为对照组）23例，术中收取患者静脉血、右侧主韧带、阴道前壁近穹隆12。组织，应用化学发光法检测静脉血血清睾酮和性激素结合球蛋白，免疫组化法及免疫印迹法检测阴道壁和主韧带雄激素受体。结果研究组血清雄激素及性激素结合球蛋白无明显变化；免疫组化检测研究组阴道壁和主韧带雄激素受体表达增加，但研究组年龄≥60岁和〈60岁雄激素受体差异无统计学意义；免疫印迹法检测研究组和对照组均能发现相对分子质量为110000及45000条带，研究组相对分子质量为110000条带与对照组差异无统计学意义，研究组主韧带相对分子质量为45000条带的表达高于对照组。结论阴道壁和主韧带组织中雄激素受体的增加可能对盆底功能障碍性疾病发生发展起着重要的作用。

Objective To evaluate the role of androgen and its receptor in the pathogenesis of prolapse of pelvic floor. Methods Specimens of right cardinal ligament and vaginal wall were collected from 38 patients with prolapse, aged（64±3）（45-79）, all menopausal, and 23 women, aged （50±2）（45- 57）, with obstetric or gynecologic diseases other than prolapse （as controls ）, all undergoing total hysterectomy. The 38 prolapse patients were divided into 2 groups： Group ≥60, aged （66± 6）, and Group 〈 60, aged （52 ±5）. Western blotting and immunohistochemistry were used to detect the expression of androgen receptor （AR） in the tissues. Peripheral blood samples were collected from all patients to examine the levels of serum testosterone and sex hormone binding globulin （SHBG） by chemiluminescent labeling. Results There were no significant differences in the serum concentrations of testosterone and SHBG between the prolapse and the control groups. The AR positive rates in the cardinal ligament and vaginal wall tissues of the prolapse patients aged ≥ 60 were （49 ± 15 ）% and （49± 10）% respectively, both not significantly different from those of the control group [ （43± 15 ） % and （42± 3 ） % respectively, both P 〉 0.05 ]. ears, The AR expression rates in the tissues of cardinal ligament and vaginal wall of the prolapse patients were （ 42 ± 3 ） % and （43 ±15 ） % respectively, both significantly higher than those of the control group [ （29 ± 7） % and （29 ± 6） % respectively, both P 〈 0.001 ]. Western blotting showed that the positive rate of the AR with the relative molecular weight of 45 000 in the cardinal ligament of the prolapse group was 4.41%, significantly higher than that of the control group （2. 1%, P=0. 02）, however, the . positive rate of the AR with the relative molecular weight of 45 000 in the vaginal wall tissue of the prolapse group was 3.34%, not significantly different from that of the control group （2.28%, P = 0. 2）. There were no significant differences in the in the straps of 110 000 and 90 000 detected by C- terminal polyantibodies of AR in the cardinal ligament and vaginal wall tissues between the prolapse patients and the control group （ both P 〉 0. 05 ）. Conclusion The increasing expression of AR in the tissue of vaginal wall and cardinal ligament of the prolapse patients with pelvic floor dysfunction may play an important role in the etiology of pelvic floor dysfunction.