阴道壁组织中TGF-β1、MMP-9、Nrf 2表达在盆底功能障碍患者中的临床意义

Clinical significance of TGF-β1,MMP-9 and Nrf 2 in vaginal wall tissues in patients with pelvic floor dysfunction

目的 探究阴道壁组织中转化生长因子-β1(TGF-β1)、基质金属蛋白酶9(MMP-9)、核因子E-2相关因子2(Nrf 2)表达在女性盆底功能障碍(PFD)患者中的临床意义。方法 以2019年3月至2021年7月于涿州市医院就诊的92例PFD患者为研究对象,根据疾病类型将其分为盆腔器官脱垂(POP)组(35例)、压力性尿失禁(SUI)组(31例)及POP合并SUI组(26例),并以47例健康妇科检查者为对照组,比较四组TGF-β1、MMP-9、Nrf 2表达量,分析其对POP、SUI的鉴别价值;比较不同严重程度POP、SUI患者的TGF-β1、MMP-9、Nrf 2表达量,分析其与病情严重程度的相关性。结果 POP合并SUI组的TGF-β1表达量低于POP组、SUI组,MMP-9、Nrf2表达量高于POP组、SUI组,差异有统计学意义(t=7.027、4.806;11.347、8.239;7.164、4.647,P均<0.05);POP组、SUI组、POP合并SUI组的TGF-β1表达量低于对照组,MMP-9、Nrf2表达量高于对照组,差异有统计学意义(t=6.105、6.819、10.009;22.425、27.123、35.601;18.029、18.521、22.992,P均<0.05);TGF-β1、MMP-9、Nrf2表达单独检测及联合检测鉴别POP及SUI的AUC分别为0.629、0.637、0.653、0.665;TGF-β1表达随POP、SUI病情的加重而降低,MMP-9、Nrf 2表达随POP、SUI病情的加重而增高,差异有统计学意义(P<0.05);TGF-β1表达与POP、SUI严重程度呈负相关(r=-0.253、-0.198,P<0.05),MMP-9、Nrf 2表达与POP、SUI严重程度呈正相关(r=0.319、0.317、0.346、0.261,P<0.05)。结论 PFD患者存在TGF-β1、MMP-9、Nrf 2异常表达现象,且各指标与病情严重程度相关,不同类型患者TGF-β1、MMP-9、Nrf 2表达水平不同,但其对PFD患者类型鉴别价值较低。

Objective To explore the clinical significance of transforming growth factor-β1(TGF-β1),matrix metalloproteinase-9(MMP-9)and nuclear factor E-2-related factor 2(Nrf2)in vaginal wall tissues in patients with pelvic floor dysfunction(PFD). Methods A total of 92 patients with PFD were enrolled as the research objects between March 2019 and July 2021. According to types of diseases,they were divided into pelvic organ prolapse(POP)group(35 cases),the stress urinary incontinence(SUI)group(31cases)and the POP-SUI group(26 cases)and 47 healthy gynecological examiners were used as the control group. The expression levels of TGF-β1,MMP-9 and Nrf2 in the three groups were compared. And their differential diagnosis value for POP and SUI was analyzed. The expression levels of TGF-β1,MMP-9 and Nrf2in patients with different severity of POP and SUI were compared. And their correlation with disease severity was analyzed. Results The TGF-β1 level in the POP-SUI group was lower than that in the POP group and the SUI group,while MMP-9 and Nrf 2 were higher than those in the POP group and the SUI group,and the differences were statistically significant(t=7.027,4.806;11.347,8.239;7.164,4.647,P<0.05). The TGF-β1level in the POP group,the SUI group and the POP-SUI group was lower than that in the control group,while MMP-9 and Nrf 2 were higher than those in the control group,and the differences were statistically significant(t=6.105,6.819,10.009;22.425,27.123,35.601;18.029,18.521,22.992,P<0.05). The AUCs of TGF-β1,MMP-9,Nrf 2 expression alone and combined detection to identify POP and SUI were 0.629,0.637,0.653,0.665,respectively. With the aggravation of POP and SUI,TGF-β1 was decreased,while MMP-9 and Nrf 2were increased,and the differences were statistically significant(P<0.05). The expression of TGF-β1 was negatively correlated with the severity of POP and SUI(r=-0.253,-0.198,P<0.05),while MMP-9 and Nrf 2were positively correlated with them(r=0.319,0.317,0.346,0.261,P<0.05). Conclusion There are abnormal expressions of TGF-β1,MMP-9 and Nrf 2 in PFD patients,which are all related to disease severity.The expression levels of TGF-β1,MMP-9 and Nrf 2 are different in different types of patients. However,their differential diagnosis value for different types of PFD patients is low.