腹股沟疝的胶原代谢紊乱及影响因素分析

Clinical analysis of collagen metabolism disorder and its influencing factors in patients with inguinal hernia

目的探讨腹股沟疝患者的胶原蛋白临床表达及代谢。方法选取2012年6月至2017年6月间于承德市鹰手营子矿区铜城人民医院接受手术治疗的成年男性腹股沟疝患者89例,其中直疝组48例,斜疝组41例。另外选取同期体检正常人群40例作为对照组。参与实验的人员中经常抽烟者共68例,其中直疝组30例,斜疝组24例,对照组14例;非经常抽烟者61例。在手术结束时收集与试者的下腹壁腹直肌前鞘组织,应用免疫组织化学方法测量腹直肌前鞘组织中Ⅰ和Ⅲ型胶原蛋白含量,将各组间Ⅰ和Ⅲ型胶原蛋白含量差异性进行对比分析。结果直疝组和斜疝组的Ⅰ型胶原蛋白含量明显低于对照组,Ⅲ型胶原蛋白含量高于对照组,Ⅰ型:Ⅲ型胶原蛋白比值均低于对照组,差异有统计学意义(F=8.053、7.331,χ~2=5.163,P<0.05、<0.05、0.036)。经常抽烟组的Ⅰ型胶原蛋白表达低于非经常抽烟组,Ⅲ型胶原蛋白表达高于非经常抽烟组,Ⅰ型:Ⅲ型胶原蛋白比值低于非经常抽烟者,差异有统计学意义(P<0.05)。结论成年腹股沟疝患者下腹壁腹直肌前鞘组织中胶原蛋白代谢紊乱可能是导致腹股沟疝患者患病的重要原因;直疝型患者胶原蛋白代谢紊乱程度大于斜疝型患者;经常抽烟者胶原蛋白代谢紊乱程度大于非经常抽烟者,吸烟是导致腹股沟疝发生的重要原因。

Objective To stu dy the clinical expression and metabolism of collagen in patients with inguinal hernia,and to provide evidence for the clinical treatment of inguinal hernia.Methods From June 2012 to June 2017,eighty-nine male patients with inguinal hernia undergoing surgical treatment in Tongcheng People＇s Hospital of Yingshouyingzi Mining Area were selected,with 48 cases of direct hernia,and indirect hernia in 41 cases.In addition,40 patients without hernia were selected as the control group.Among the participants in the experiment,regular smokers were 68 cases,including 30 cases of direct hernia group,24 cases of indirect hernia group,14 cases in the control group.61 cases were no frequent smokers.Abdominal rectus and anterior sheath tissue at the end of surgery were collected,collagen immunohistochemical method was used to measure the anterior rectus sheath tissues in type Ⅰ and Ⅲ,and to compare the differences between group Ⅰ and group Ⅲ collagen content.Results Type Ⅰ collagen content of direct inguinal hernia group and indirect hernia group was significantly lower than that of the control group,while type Ⅲ collagen content was higher than the control group,and collagen ratio of type Ⅰ：type Ⅲ in direct and indirect hernia group was lower than the control group,the differences were statistically significant（F=8.053,7.331,χ^2=5.163,P〈0.05,0.05,0.036）.Compared with indirect hernia group,type Ⅰ collagen expression was lower than direct hernia group,type Ⅲ collagen expression was higher than direct hernia group,type Ⅰ：Ⅲ collagen ratio was lower than the hernia group,the difference was statistically significant（P〈0.05）.Type Ⅰ collagen of the smoker group was lower than that in non smoking group,and type Ⅲ collagen expression was higher than that of non smoking group,type Ⅰ：Ⅲ collagen ratio lower than non smokers,the difference was statistically significant（P〈0.05）.Conclusions The disorder of collagen metabolism in the anterior sheath of the abdominal rectus abdominis in patients with adult inguinal hernia may be an important reason for the morbidity of inguinal hernia.Collagen metabolism disorder in direct type patients is higher than in patients with indirect inguinal hernia.The metabolic disorder of collagen is more frequent in smokers than in non smokers.Smoking is an important factor for the occurrence of inguinal hernia.