血清弹性蛋白酶抑制因子、骨桥蛋白及盆底电生理与盆底功能障碍性疾病的相关性研究

Correlations between serum elafin,osteopontin,pelvic floor electrophysiology and pelvic floor dysfunction diseases

目的探讨血清弹性蛋白酶抑制因子(elafin)、骨桥蛋白(OPN)及盆底电生理与盆底功能障碍性疾病(PFD)的相关性。方法选取39例单纯盆腔脏器脱垂(POP)患者为单纯POP组,58例POP合并压力性尿失禁(SUI)患者为POP合并SUI组,63例无PFD女性体检者为对照组,检测3组血清elafin、OPN水平以及盆底肌力和疲劳度。采用Pearson相关或Spearman秩相关分析elafin、OPN与盆底肌力和疲劳度的相关性,采用Logistic回归分析探讨影响PFD发病的因素。结果血清elafin水平、Ⅰ类肌纤维肌电压、Ⅱ类肌纤维肌电压在对照组、单纯POP组、POP合并SUI组中依次降低,血清OPN水平、Ⅰ类肌纤维疲劳度绝对值、Ⅱ类肌纤维疲劳度绝对值依次升高,差异均有统计学意义(P<0.05)。血清elafin水平、Ⅰ类肌纤维肌电压、Ⅱ类肌纤维肌电压在POP、SUI的Ⅰ度、Ⅱ度、Ⅲ度患者中依次降低,血清OPN水平、Ⅰ类肌纤维疲劳度绝对值、Ⅱ类肌纤维疲劳度绝对值依次升高,差异有统计学意义(P<0.05)。Spearman秩相关分析显示,血清elafin水平、Ⅰ类肌纤维肌电压、Ⅱ类肌纤维肌电压与POP、SUI分度呈负相关(P<0.05),血清OPN水平、Ⅰ类肌纤维疲劳度、Ⅱ类肌纤维疲劳度与POP、SUI分度呈正相关(P<0.05)。Pearson相关分析显示,Ⅰ类肌纤维肌电压、Ⅱ类肌纤维肌电压与elafin水平呈正相关(P<0.05),与OPN呈负相关(P<0.05),Ⅰ类肌纤维疲劳度、Ⅱ类肌纤维疲劳度与elafin水平呈负相关(P<0.05),与OPN呈正相关(P<0.05)。Logistic回归分析显示,年龄、产次、绝经、OPN、elafin与PFD发生具有相关性(P<0.01)。结论PFD患者血清elafin水平、盆底肌纤维肌电压降低,OPN水平、盆底肌肉疲劳度升高,elafin、OPN、盆底肌纤维肌电压和疲劳度均与PFD发生以及程度有关。

Objective To investigate the correlations between serum elafin,osteopontin(OPN),pelvic floor electrophysiology and pelvic floor functional disorders(PFD).Methods Totally 39 patients with simple pelvic organ prolapse(POP),58 patients with POP and stress urinary incontinence(SUI)and 63 women without PFD were selected as simple POP group,POP plus SUI group and control group respectively,and serum levels of elafin,OPN,pelvic floor muscle strength and fatigue were detected.Pearson correlation or Spearman rank correlation was used to analyze the correlations between elafin,OPN and pelvic floor muscle strength as well as fatigue,and Logistic regression analysis was used to explore the factors affecting the incidence of PFD.Results The level of serum elafin,the muscle voltage of type Ⅰ muscle fiber and the muscle voltage of type Ⅱ muscle fiber gradually decreased in the control group,the simple POP group and the POP plus SUI group,while the level of serum OPN,absolute value of fatigue degree of type Ⅰ muscle fiber and absolute value of fatigue degree of type Ⅱ muscle fiber gradually increased in the above three groups(P<0.05).The level of serum elafin,muscle voltage of type Ⅰ muscle fiber and muscle voltage of type Ⅱ muscle fiber gradually decreased in cases with degree Ⅰ ,Ⅱ and Ⅲ of POP and SUI,while the level of serum OPN,absolute value of fatigue degree of type Ⅰ muscle fiber and absolute value of fatigue degree of type Ⅱ muscle fiber gradually increased in the above cases(P<0.05).Spearman rank correlation analysis showed that serum elafin level,muscle voltage of type Ⅰ muscle fiber and muscle voltage of type Ⅱ muscle fiber were negatively correlated with grading of POP and SUI(P<0.05),while serum OPN level,fatigue degree of type Ⅰ muscle fiber and fatigue degree of type Ⅱ muscle fiber were positively correlated with grading of POP and SUI(P<0.05).Pearson correlation analysis showed that muscle voltages of type Ⅰ and Ⅱ muscle fibers were positively correlated with elafin level,and negatively correlated with OPN(P<0.05).Fatigue degrees of type Ⅰ and Ⅱ muscle fibers were negatively correlated with elafin level,and positively correlated with OPN(P<0.05).Logistic regression analysis showed that age,number of deliveries,menopause,OPN and elafin were correlated with incidence of PFD(P<0.01).Conclusion In the patients with PFD,the level of serum elafin and muscle voltage of pelvic floor muscle fiber decrease,while the level of OPN and fatigue degree of pelvic floor muscle increase,and elafin,OPN,voltage and fatigue of pelvic floor muscle fibers are related to the occurrence and degree of PFD.