宫缩乏力性产后出血患者MAPK表达水平与BKCa、PGs的相关性

Correlation between MAPK expression level and BKCa and PGS in patients with uterine inertia-related postpartum hemorrhage.

目的探究丝裂原激活蛋白激酶(MAPK)表达水平与宫缩乏力性产后出血患者大电导钙激活钾通道(BKCa)、前列腺素(PGs)的相关性。方法回顾性选择2017年12月至2018年12月在恩施州土家族苗族自治州中心医院产科接受剖宫产的产妇88例,将宫缩乏力性产后出血的产妇41例设为研究组,将宫缩正常无产后出血的产妇47例设为对照组。剖宫产术中收集两组产妇子宫肌组织适量,采用等长张力测定方法检测子宫肌收缩力,采用酶联免疫吸附试验测定子宫肌组织中前列腺素E2(PGE2)、前列腺素F2α(PGF2α)、6-Keto-PGF1α、血栓烷B2(TXB2)、MAPK水平;采用RT-PCR检测子宫肌组织中BKCa通道α亚基和β亚基mRNA表达量;采用Pearson相关分析MAPK表达水平与宫缩乏力性产后出血患者BKCa、PGE2、PGF2α、6-Keto-PGF1α、TXB2的相关性。结果研究组产妇子宫肌的自发性及应用缩宫素后的收缩频率和收缩活动力以及收缩幅度明显低于对照组,差异均有统计学意义(P<0.05)。研究组产妇子宫肌中PGE2、PGF2α、TXB2、MAPK水平明显低于对照组,6-Keto-PGF1α水平及BKCa通道α亚基和β亚基mRNA表达量明显高于对照组,差异均有统计学意义(P<0.05)。Pearson相关性分析显示,MAPK表达水平与宫缩乏力性产后出血患者PGE2、PGF2α、TXB2含量呈正相关(r=0.568、0.517、0.659,P<0.05),与6-Keto-PGF1α、BKCa通道α亚基和β亚基含量呈负相关(r=-0.724、-0.506、-0.623,P<0.05)。结论MAPK表达水平与宫缩乏力性产后出血患者6-Keto-PGF1α、BKCa通道α亚基和β亚基含量呈负相关,MAPK表达水平与宫缩乏力性产后出血患者PGE2、PGF2α、TXB2含量呈正相关,MAPK表达下调可能会增加6-Keto-PGF1α、BKCa通道α亚基和β亚基表达导致宫缩乏力性产后出血发生。

Objective To investigate the correlation between the expression of mitogen-activated protein kinase(MAPK)and the large-conductance calcium-activated potassium channel(BKCa)and PGs in patients with uterine inertia-related postpartum hemorrhage.Methods A total of 88 women who underwent cesarean section in the Department of Obstetrics,Women's and Children's Hospital,Central Hospital of Tujia and Miao Autonomous Prefecture from December 2017 to December 2018 were retrospectively divided into the study group(n=41,uterine inertia-related postpartum hemorrhage)and the control group(n=47,normal uterine contraction without postpartum hemorrhage).The adequate uterine muscle tissue of the two groups was collected during cesarean section.The contraction force of the uterus muscle was measured by isometric tension assay.The prostaglandin E2(PGE2),prostaglandin F2α(PGF2α),6-Keto-PGF1α,thromboxane B2(TXB2)and MAPK levels in the uterine muscle tissue was determined by enzyme-linked immunosorbent assay.The mRNA expression of BKCa channelαsubunit andβsubunit in uterine muscle tissue was measured by RT-PCR.The Pearson correlation analysis was used to analyze the correlation between MAPK expression level and BKCa,PGE2,PGF2α,6-Keto-PGF1αand TXB2 in patients with uterine inertia-related postpartum hemorrhage.Results The spontaneity of uterine muscle and the contraction frequency,contractile activity and contraction amplitude after oxytocin in the study group were significantly lower than those in the control group,the differences were statistically significant(P<0.05).The levels of PGE2,PGF2α,TXB2,MAPK in the maternal uterine muscle of the study group was significantly lower than those of the control group,the level of 6-Keto-PGF1αand mRNA expression of BKCa channelαsubunit andβsubunit in the uterine muscle of the study group were significantly higher than those of the control group,the differences were statistically significant(P<0.05).Pearson correlation analysis showed that the expression level of MAPK was positively correlated with the levels of PGE2,PGF2αand TXB2 in patients with uterine inertia-related postpartum hemorrhage(r=0.568,0.517,0.659,P<0.05),and negatively correlated with the content of 6-Keto-PGF1α,BKCa channelαsubunit andβsubunit(r=-0.724,-0.506,-0.623,P<0.05).Conclusion The expression of MAPK is negatively correlated with the levels of 6-Keto-PGF1α,BKCa channelαsubunit andβsubunit in patients with uterine inertia-related postpartum hemorrhage;Expression of MAPK and PGE2,PGF2 in postpartum hemorrhage patients with uterine atonyα,the content of TXB2 was positively correlated.Hence,down-regulation of MAPK may increase the expression of 6-Keto-PGF1αand BKCa channelαsubunit andβsubunit expression resulting in uterine inertia-related postpartum hemorrhage.