纤维蛋白溶解系统和转化生长因子-1在子宫全切除术后腹腔粘连发病机制中的作用

The role of fibrinolytic system and transforming growth factor-1 in the pathogenesis of peritoneal adhesions after total hysterectomy

目的检测组织纤溶酶原激活物(t-PA)、纤溶酶原激活剂抑制物(PAI-1)和转化生长因子-β(TGF-β)在术后腹腔粘连中的表达,分析其在子宫全切除术后腹腔粘连发生发展过程中的作用,探讨腹腔粘连发生机制。方法选择本院子宫肌瘤患者60例,均行子宫全切除术,开腹手术30例(开腹组),腹腔镜手术30例(腹腔镜A组),收集同期行腹腔镜下卵巢囊肿剥除术病例30例(腹腔镜B组)。开腹组腹膜打开后、术中间隔30 min、关腹前,腹腔镜组在气腹形成后、术中间隔30 min、结束气腹前分别取外周血5 mL和腹膜;并于术后1 d、2 d、3 d抽取外周静脉血5 mL,检测血液t-PA、PAI-1浓度,组织TGF-β蛋白和TGF-β基因表达。结果开腹组术中、关腹前血清t-PA为(27.79±1.76)ng/L和(24.68±1.73)ng/L,低于腹腔镜A组和B组患者,开腹组术中、关腹前血清PAI-1为(22.46±1.22)μg/L和(24.31±1.80)μg/L,高于腹腔镜A组和B组患者,差异有统计学意义(P<0.05)。开腹组关腹前组织TGF-β蛋白、TGF-β基因分别为(2.59±0.63)和(34.74±1.92),均高于腹腔镜A组和B组患者,差异有统计学意义(P<0.05);开腹组术后1 d、2 d、3 d血清t-PA低于腹腔镜A组和B组患者,PAI-1高于腹腔镜A组和B组患者,差异有统计学意义(P<0.05)。结论开腹组患者PAI-1、TGF-β蛋白和基因表达呈现较强表达,PAI-1随着手术时间的延长而增加,t-PA浓度显著降低,随着手术时间的延长而下降。

Objective To investigate the expression of tissue plasminogen activator （t-PA）, plasminogen activator inhibitor（PAI-1 ）and transforming growth factor-β （TGF-β） in postoperative peritoneal adhesions, and to analyze their role in the development of abdominal adhesions after total hysterectomy,and to explore mechanism of abdominal adhesions. Methods 60 patients with uterine leiomyoma were enrolled in this study. All patients underwent total hysterectomy. Theire were 30 patients undergoing laparotomy （laparotomy group） and 30 patients undergoing laparoscopic surgery （laparoscopic group A）.30 cases of laparoscopic ovarian cystectomy in the same period were collected （laparoscopic group B）. 5 mL peripheral blood and peritoneum were taken after the opening of peritoneum,intraoperative interval of 30 minutes and before the closing of abdomen in the laparotomy group and after the formation of pneumo-peritonemn, intraoperative interval of 30 minutes and before the end of pneumoperitoneum in the laparoscopic group. The expression levels of blood t-PA, PAI-1 concentration, and TGF-β protein and TGF-β gene in tissue were detected by immunohistochemistry at first day, second day and third day after operation. Results The levels of serum t-PA during surgery and before the closing of abdomen were（27.79±1.76）ng/L and（24.68±1.73）ng/L in laparotomy group, which were lower than those of laparoscopic group A and group B. And the levels of serum PAI-1 during surgery and before the closing of abdomen were （22.46± 1.22）μg/L and （24.31± 1.80） μg/L ,which were higher than those of laparoscopic group A and group B. And the differences were significant （P〈0.05）. The levels of tissue TGF-I3 protein and TGF-~ gene were （2.59＋0.63） and （34.74-＋1.92） in the laparotomy group, which were significantly higher than those in the laparoscopic group A and group B, and the differences were significant （P〈0.05）. The serum t-PA level in laparotomy group was lower than that in the laparoscopic group A and group B at first day, second day and third day after operation. And the level of PAI-1 in laparotomy group was higher than that in laparoscopic group A and group B, and the differences were statistically significant（P〈O.05）. Conclusion PAl-I, TGF-β protein and gene in the laparotomy group were strongly ex- pressed in the laparotomy group, t-PA concentration decreased significantly, and decreased with the operation time.