妊娠期压力性尿失禁妇女盆底肌肉细胞外基质特征分析

Features of extracellular matrix of pelvic floor muscles in pregnant women with stress urinary incontinence

目的研究妊娠期压力性尿失禁(SUI)妇女盆底肌肉细胞外基质的特征。方法选取行定期产前检查并阴道分娩的初产妇女71例,其中SUI组33例,非SUI组38例,于胎儿娩出后取会阴侧切处深部组织行HE染色、电子显微镜超微结构观察,Masson三色染色和EVG弹性纤维染色定量分析盆底肌肉组织胶原纤维和弹性纤维含量;另选择同期3名非妊娠女性作为非妊娠组。结果妊娠晚期妇女会阴深部组织平滑肌细胞不同程度空泡变性、肌纤维直径变细,细胞间质水肿。非SUI组盆底肌肉组织中横纹肌周围有丰富胶原包绕,结构紧密并见成束弹性纤维;SUI组盆底组织以平滑肌为主,细胞外胶原结构稀疏,弹性纤维稀少,平滑肌肌束内多量胶原分布。SUI组盆底肌肉组织胶原纤维相对含量和弹性纤维相对含量均显著小于非SUI组(P<0.05)。结论妊娠期SUI妇女盆底肌肉组织细胞外基质结构疏松,胶原纤维和弹性纤维含量下降,可能与SUI的发生有关。

To explore the features of extracellular matrix of pelvic floor muscles in pregnant women with stress urinary incontinence （SUI）. Methods Seventy-one primiparas with regular prenatal examination undergoing vaginal delivery were selected, and were divided into SUI group （n = 33） and non-SUI group （n = 38）. Deep pelvic floor tissues were obtained after delivery, HE staining was conducted, electronic microscopy was performed for uhrastructure observation, and quantitative analysis of collagen and elastic fibers was carried out with Masson＇s trichrome staining and Verhoeff-van Gieson staining. Besides, another 3 women without pregnancy were served as non-pregnant controls. Results There were vacuolar degeneration, filament alteration and edema in smooth muscle cells of deep pelvic floor tissues in all pregnant women. There were plentiful of collagen and elastic fibers around striated muscles in non-SUI group. The main component of deep pelvic floor tissues in SUI group was smooth muscle, and there were sparse collagen and elastic fibers around smooth muscles. The relative contents of collagen fibers and elastic fibers of pelvic floor muscle tissues in SUI group were significantly lower than those in non-SUI group （P 〈 0.05）. Conclusion The extracellular matrix structure of pelvic floor muscle tissues in pregnant women with SUI is loose, with less collagen fibers and elastic fibres, which may be associated with the occurence of SUI.