先天性尿道下裂和单纯性阴茎下曲患者阴茎皮肤组织中雄激素受体表达研究

EXPRESSION OF ANDROGEN RECEPTOR IN GENITAL TISSUE OF PATIENTS WITH CONGENITAL HYPOSPADIAS AND SIMPLE CHORDEE

目的观察先天性尿道下裂和单纯性阴茎下曲患者阴茎皮肤组织中雄激素受体(androgen receptor,AR)的表达情况,探讨其在不同程度尿道下裂和阴茎下曲中的表达特征及规律。方法以2005年8月-2007年1月行矫正术的25例先天性尿道下裂和4例单纯性阴茎下曲患者为研究对象,采集阴茎背侧包皮、尿道口腹侧皮肤和尿道板组织。尿道下裂患者年龄1岁11个月～19岁,平均3岁7个月;阴茎下曲患者年龄3岁6个月～16岁,平均7岁1个月。以18例行包皮环切术患者的正常背、腹侧包皮作为对照。免疫组织化学染色观察并检测标本AR的表达水平和分布情况,行统计学分析。结果先天性尿道下裂、单纯性阴茎下曲和正常包皮组织中均有AR表达。正常阴茎背、腹侧包皮AR表达核阳性细胞率分别为62.94%±5.40%、62.87%±5.33%;先天性尿道下裂阴茎背侧包皮、尿道口腹侧皮肤及尿道板组织分别为59.00%±3.75%、58.46%±4.14%、52.30%±3.53%,AR表达均低于正常背、腹侧包皮(P<0.05);且尿道板组织AR表达显著低于自身背、腹侧包皮皮肤(P<0.05),自身背、腹侧包皮皮肤间差异无统计学意义(P>0.05)。与正常背、腹侧包皮比较:远、中段型尿道下裂阴茎背侧包皮AR表达差异无统计学意义(P>0.05),但尿道板组织AR表达显著降低(P<0.05);近段型背侧包皮、尿道口腹侧皮肤及尿道板组织AR表达均降低(P<0.05);下曲<45°者阴茎背侧包皮、尿道口腹侧皮肤AR表达差异无统计学意义(P>0.05),下曲≥45°者比较差异均有统计学意义(P<0.05),两组尿道板组织AR表达均降低(P<0.05)。单纯性尿道下曲患者阴茎背侧包皮、尿道口腹侧皮肤及尿道板组织AR表达核阳性细胞率分别为59.69%±2.73%、55.71%±1.67%、51.92%±1.87%,与正常包皮组织比较,AR表达呈减弱趋势。结论先天性尿道下裂及单纯性阴茎下曲阴茎皮肤组织AR表达低于正常阴茎,尿道板组织AR缺陷突出。

Objective To investigate the localization and expression characteristics of androgen receptor（AR） in genital tissue of patients with congenital hypospadias and simple chordee.Methods Between August 2005 and January 2007,dorsal prepuce,ventral perimeatal skin,and urethral plate were harvested from 25 patients with congenital hypospadias（aged from 1 year and 11 months to 19 years with an average of 3 years and 7 months） and 4 patients with simple chordee（aged from 3 years and 6 months to 16 years with an average of 7 years and 1 month）.Prepuce by circumcision from 18 patients was used as control.The expression intensity and distribution of AR were assessed with immunohistochemistry.Results AR was expressed in prepuce tissues from congentital hypospadias,simple chordee,and control.The AR positive cell rates were 62.94% ± 5.40% and 62.87% ± 5.33% in dorsal and ventral prepuce of control patients respectively,and were 59.00% ± 3.75%,58.46% ± 4.14%,and 52.30% ± 3.53% in dorsal prepuce,ventral perimeatal skin,and urethral plate of patients with congenital hypospadias respectively.AR positive cell rate was significantly lower in patients with congenital hypospadias than in control patients（P 0.05）,and in urethral plate than in dorsal prepuce and ventral perimeatal skin of patients with congenital hypospadias（P 0.05）,and no significant difference was detected between dorsal and ventral specimens（P 0.05）.Stratified analysis showed a similar expression mode in severe hypospadias group and severe chordee group（P 0.05）.In mild to moderate hypospadias group and mild to moderate chordee group,no significant difference was shown when dorsal and ventral skin specimens were compared to that in normal control（P 0.05）,with AR expression diminished in urethral plate（P 0.05）,and AR decrease was relative to severity of chordee（P 0.05）.The AR positive cell rates were 59.69% ± 2.73%,55.71% ± 1.67%,and 51.92% ± 1.87% in dorsal,ventral skin,and urethral plate of patients with chordee respectively.Reducing tendency of AR expression was observed.Conclusion AR expression decreases in penile skin of patients with congenital hypospadias and simple chordee,especially in urethral plate.