前列腺增生后逼尿肌结构功能改变对肌聚糖表达的影响及其临床意义

Expression and Clinical Significance of Sarcoglycan Protein in Different Human Detrusor after BPH

目的检测前列腺增生后不同逼尿肌结构功能状态下肌聚糖(sarcoglycan,SG)的表达,分析SG的表达与逼尿肌收缩功能改变的相关性及临床意义。方法分析56例前列腺增生患者逼尿肌标本,其中,逼尿肌收缩力下降组26例,逼尿肌收缩力正常组30例,选择同期因膀胱肿瘤住院患者25例作为阴性对照组;常规检查收集患者年龄、前列腺体积、PSA指标、Qmax和Pdet-Qmax尿动力学参数等临床数据;所有膀胱逼尿肌均经HE染色病理学检查;用免疫组织化学技术和实时定量荧光PCR(real-time PCR)技术分别检测逼尿肌中SG的α、β、γ亚基的m RNA和蛋白水平;用等级相关法分析各组之间的差异以及SG表达与临床数据的关系。结果与对照组相比,下降组的平滑肌肌纤维断裂,密度降低,排列稀疏,细胞之间的间隙增宽,且可见结缔组织增生及大量炎性细胞浸润,正常组的平滑肌肌纤维排列紧密,无变性坏死等表现;3组两两相比较,下降组SG的α、β、γ亚基m RNA和蛋白表达水平显著性下降(P<0.05),而正常组其表达量未见显著性改变(P>0.05);前列腺增生患者中SG的α、β、γ亚基蛋白的表达与最大尿流率时逼尿肌压(Pdet-Qmax)呈正相关(P<0.01)。结论 SG表达的下降与前列腺增生后造成膀胱逼尿肌的收缩力下降有关,检测SG表达有助于了解前列腺增生后造成逼尿肌收缩力改变的分子生物学机制,以期为今后相关的诊治提供新的思路及理论基础。

Objective To discover the expression of Sarcoglycan（SG）in different detrusor after BPHand investigate the relationship to the different detrusor and clinical significance of SG. Methods Fifty six cases of BPH and 25 patients without urinary tract obstruction who were operated on in the same period for study. Among the case of BPH, 30 cases were with normal detrusor function, and 26 cases of underactive detrusor. Age, prostate volume,PSA, Qmax and Pdet-Qmax were collctted. All detrusor were confirmed detected by HE staining. The expressions of α-SG、β-SG、γ-SG in detrusor tissue were detected by immunohistochemical technique and RT-qPCR respectively, and its clinical significance was analyzed. Results Compared to the group without BPH,the fiber of bladder detrusor were decreased and the fiber distribution were sparse, thinner and fracture and more connective tissue,inflammatory cells in underactive detrusor group.In the group of normal detrusor function, fiber tightly packed, without necrosis. The expression of α-SG,β-SG,γ-SG in detrusor were decreased in underactive detrusor group significantly（P〈0.05）,while in normal detrusor function group,there was no different （P＞0.05）. Correlation analysis showed that the expressions of sarcoglycans had a positive correlation with the detrusor pressure at maximum flow rate in BOO（P〈0.01）. Conclusion The decrease of SG might be related to the underactive detrusor after BPH. By detecting the expression of SG can judgment the mechanism of detrusor change after BPH,thus provides a new method and theory for patient who with underactive detrusor in the future.