青海地区不同海拔男性腹股沟疝患者腹壁组织Ⅰ、Ⅲ型胶原纤维表达的研究

Study on the expression of type I and III collagen fibers in abdominal wall tissues of male inguinal hernia patients at different altitudes in Qinghai region

目的研究在不同海拔腹股沟疝患者的腹横筋膜Ⅰ型和Ⅲ型胶原纤维表达的含量,探究其胶原含量及比例是否存在差异。方法选取2022年9月至2023年5月在青海省人民医院普外科接受腹股沟疝手术的159例男性患者作为研究对象,分为海拔<2500 m组64例、2500~3500 m组48例及>3500 m组47例。检测标本取自腹横筋膜,面积约为10 mm×5 mm,免疫组织化学法检测Ⅰ、Ⅲ型胶原蛋白表达评分。结果Ⅰ型胶原纤维蛋白在<2500 m组的直疝中表达评分为21.0(10.5,24.0),斜疝表达评分为22.0(16.5,27.0),>3500 m组的直疝表达评分为10.0(6.0,15.5),斜疝表达评分为15.0(10.0,18.0),<2500 m组Ⅰ型胶原纤维蛋白表达含量高于>3500 m组。Ⅲ型胶原纤维蛋白在>3500 m组的直疝表达为16.0(14.0,20.8),斜疝表达评分为13.0(12.0,15.0),<2500 m组的直疝表达评分为10.0(10.0,16.0),斜疝表达评分为8.0(7.0,14.0),<2500 m组Ⅲ型胶原纤维蛋白表达含量低于>3500 m组;Ⅰ/Ⅲ值在<2500 m组的直疝为1.240(0.723,1.794),斜疝为1.969(1.286,3.375),>3500 m组的直疝为0.454(0.375,1.019),斜疝为0.833(0.692,1.308);各组中斜疝患者Ⅰ型/Ⅲ型的值高于直疝患者,差异均有统计学意义(P<0.05)。结论直疝和斜疝患者随着海拔变化,胶原含量存在差异,相较于<2500 m,海拔>3500 m对胶原纤维含量的负面影响更为显著;直疝患者胶原含量及比例与斜疝患者有差异,海拔变化对直疝患者群体的胶原代谢的影响更为突出。

Objective To investigate the expression levels of typeⅠandⅢcollagen fibers in the transversalis fascia of inguinal hernia patients at different altitudes and to explore whether there are differences in collagen content and ratio.Methods In this study,159 male patients who received inguinal hernia surgery in the Department of General Surgery of Qinghai Provincial People's Hospital from September 2022 to May 2023 were selected as the study objects,and were divided into 64 cases in the<2500 m group,48 cases in the 2500~3500 m group,and 47 cases in the>3500 m group.The samples were collected from the transversalis fascia,the area was about 10 mm×5 mm,and the expression scores of collagenⅠandⅢwere detected by the immunohistochemical(SP)method.Results The expression score of type I collagen fibers in the direct hernia of the<2500 m group was 21.0(10.5,24.0),and 22.0(16.5,27.0)in the indirect hernia;in the>3500 m group,the score was 10.0(6.0,15.5)for direct hernia and 15.0(10.0,18.0)for indirect hernia.The expression level of typeⅠcollagen fibers in the<2500 m group was higher than in the>3500 m group.For typeⅢcollagen fibers,the expression score in the>3500 m group was 16.0(14.0,20.8)for direct hernia and 13.0(12.0,15.0)for indirect hernia,while in the<2500 m group,the score was 10.0(10.0,16.0)for direct hernia and 8.0(7.0,14.0)for indirect hernia.The expression level of typeⅢcollagen fibers in the<2500 m group was lower than in the>3500m group.TheⅠ/Ⅲratio was 1.240(0.723,1.794)for direct hernia and 1.969(1.286,3.375)for indirect hernia in the<2500 m group,and 0.454(0.375,1.019)for direct hernia and 0.833(0.692,1.308)for indirect hernia in the>3500 m group.TheⅠ/Ⅲratio in indirect hernia patients was higher than that in direct hernia patients.These differences were statistically significant(P<0.05).Conclusion The collagen content varies with altitude in direct and indirect hernia patients.Compared to<2500 m,the negative impact on collagen fiber content was more significant at an altitude of>3500 m.There were differences in collagen content and ratio between direct and indirect hernia patients,with altitude changes having a more pronounced effect on collagen metabolism in direct hernia patients.