盆腔器官脱垂患者阴道前壁组织中弹性蛋白和细胞外基质蛋白fibulin-5的表达及意义

Expression and significance of elastin and fibulin-5 in anterior vaginal tissue of women with pelvic organ prolapse

目的探讨盆腔器官脱垂（POP）患者阴道前壁组织中弹性蛋白和细胞外基质蛋白fibulin-5的表达变化及其临床意义。方法选择中国医科大学附属盛京医院妇产科2006年11月至2008年6月诊断为POP并行手术治疗的68例患者的膨出阴道前壁组织（POP组）。POP组患者依据POP定量分度（POP-Q）法，分为I度10例、Ⅱ度21例、Ⅲ度25例、Ⅳ度12例。选择同期因宫颈鳞癌Ib期行子宫全切除＋双侧附件切除术的18例患者的阴道前壁切除组织石蜡标本作为对照组。免疫组化染色法检测两组阴道前壁组织中fibulin-5和弹件蛋白的表达。结果（1）弹性蛋白和fibulin-5在阴道前壁组织中的表达主要定位于细胞外基质。（2）POP组患者阴道前壁组织中fibulin-5的阳性表达率为15％（10／68），低于对照组的44％（8／18），差异有统计学意义（P=0．010）。POP组患者阴道前壁组织中fibulin-5的阳性表达率，POP-Q分度为Ⅲ、Ⅳ度者[5％（2／37）]低于I、Ⅱ度者[26％（8／31）]，差异有统计学意义（P=0．035）；已绝经者[13％（8／60）]与未绝经者（2／8）比较，阴道分娩≤2次者[19％（5／27）]与〉2次者[12％（5／41）]比较，差异均无统计学意义（P〉0．05）。（3）POP组患者阴道前壁组织中弹性蛋白的阳性表达率为31％（21／68），低于对照组的72％（13／18），差异有统计学意义（P=0．002）。POP组患者阴道前壁组织中弹性蛋白的阳性表达率，POP-Q分度为Ⅲ、Ⅳ度者[19％（7／37）]低于I、Ⅱ度者[45％（14／31）]，差异有统计学意义（P=0．034）；已绝经者[30％（18／60）]与未绝经者（3／8）比较，阴道分娩≤2次者[26％（7／27）]与〉2次者[34％（14／41）]比较，差异均无统计学意义（P〉0．05）。（4）POP组68例患者阴道前肇组织中，fibulin-5与弹性蛋白表达均为阳性者6例，均为阴性者43例，fibulin-5与弹性蛋白在POP组患者阴道前壁组织中的表达旱正相关关系（P=0．031）。结论POP患者盆底结缔组织中弹性蛋白和fibulin-5表达下降，并与POP严重程度相关。

Objective To investigate the expression and significance of elastin and fibulin-5 in anterior vaginal tissue of women with pelvic organ prolapse （POP）. Methods Between November 2006 and June 2008, 68 patients with POP underwent surgical treatment in Shengjing Hospital of China Medical University were enrolled in this study, who were classified into 10 patients with grade I , 21 patients with grade Ⅱ , 25 patients with grade Ⅲ and 12 patients with grade Ⅳ in accordance with pelvic organ prolapse quantitation （POP-Q）. Meanwhile, 18 cases with early cervical cancer at stage of I b were treated by total hysterectomy and bilateral salpingo-oophorectomy, their anterior vaginal tissues were selected as controls. Immunohistochemical staining was performed to detect the expression of elastin and fibulin-5. Results （ 1 ）Elastin and fibulin-5 were mainly expressed at extracellular matrix（ECM）. （2）The positive rate of fibulin-5 expression in anterior vaginal wall were 5% （2/37）in grade Ⅲ/Ⅳ and 26% （8/31）in grade Ⅰ/Ⅱ POP patients, which reached statistical difference （ P = 0. 035 ）. However, no statistical different expression was found between postmenopausal （ 13%, 8/60 ） and non-menopausal patients （ 2/8 ）, vaginal delivery ≤ 2 （19%, 5/27） and 〉 2 patients（ 12%, 5/41, P 〉 0. 05）. （3） The positive rate of elastin expression in anterior vaginal wall in POP group was 31% （21/68）, which was significantly lower than 72% （13/18）of control group （P = 0. 002）. Among POP group, 19% （7/37） of elastin expression in grade Ⅲ/Ⅳ POP was significantly lower than 45% （ 14/31 ） in grade Ⅰ/ Ⅱof POP patients. However, no statistical difference was found between postmenopausal （ 30% , 18/60 ） and non-menopausal patients （ 3/8 ）, vaginal delivery ≤ 2 （26%, 7/27） and 〉2 patients（34%, 14/41, P〉0. 05）. （4）In POP group, both positive expression of fibulin-5 and elastin of anterior vaginal wall was in 6 cases, both negative expression of fibulin-5 and elastin was in 43 cases. It was illustrated that elastin and fibulin-5 had an positive relationship （ P = 0. 031 ）. Conclusion The decreased expression of elastin and fibulin-5 was correlated with degree of POP, which indicated that elastin and fibulin-5 may play a role in the pathogenesis of POP.