CAJ | 학술논문

目的：探讨阴道壁组织中弹力纤维、胶原纤维、fibulin-5和转化生长因子β（TGF-β）与初产妇妊娠晚期盆底功能障碍的关系。方法：选取阴道分娩并行会阴侧切的初产妇40例，无妊娠期高血压、妊娠期糖尿病、胎儿生长受限（FGR）和巨大儿。将既无阴道前壁脱垂也无压力性尿失禁（SUI）初产妇设为对照组（20例），将阴道前壁脱垂（包括Ⅰ度和Ⅱ度脱垂的）合并SUI初产妇设为病例组（20例）。所有研究对象阴道分娩行会阴侧切时取少许阴道壁组织行Masson染色检测弹力纤维和胶原纤维的差异，免疫组织化学检测fibulin-5和TGF-β的表达情况，免疫组化结果使用Image-Pro Plus软件分析。结果：2组患者TGF-β蛋白表达量差异无统计学意义（t=1.670，P=0.098），对照组fibulin-5蛋白表达量高于病例组（t=3.062，P=0.005）。病例组胶原纤维和弹力纤维排列稀疏、紊乱，且纤维之间出现断裂，对照组纤维排列致密，形态完整。结论：妊娠期盆底弹力纤维和胶原纤维的异常以及fibulin-5表达减少可能与妊娠期盆底功能障碍发病有关。
목적：탐토음도벽조직중탄력섬유、효원섬유、fibulin-5화전화생장인자β（TGF-β）여초산부임신만기분저공능장애적관계。방법：선취음도분면병행회음측절적초산부40례，무임신기고혈압、임신기당뇨병、태인생장수한（FGR）화거대인。장기무음도전벽탈수야무압력성뇨실금（SUI）초산부설위대조조（20례），장음도전벽탈수（포괄Ⅰ도화Ⅱ도탈수적）합병SUI초산부설위병례조（20례）。소유연구대상음도분면행회음측절시취소허음도벽조직행Masson염색검측탄력섬유화효원섬유적차이，면역조직화학검측fibulin-5화TGF-β적표체정황，면역조화결과사용Image-Pro Plus연건분석。결과：2조환자TGF-β단백표체량차이무통계학의의（t=1.670，P=0.098），대조조fibulin-5단백표체량고우병례조（t=3.062，P=0.005）。병례조효원섬유화탄력섬유배렬희소、문란，차섬유지간출현단렬，대조조섬유배렬치밀，형태완정。결론：임신기분저탄력섬유화효원섬유적이상이급fibulin-5표체감소가능여임신기분저공능장애발병유관。
Objective:To explore the relationship between the dysfunction of pelvic floor in primipara and the expression of elastin、collagen、fibulin-5 and TGF-βin vaginal wall. Methods:The subjects composed of primipara delivered in Maternal and Child Health Care Center of Jiading District,without complications of hypertention,GDM,FGR and fetal macrosomia,aged 20-30 years. The study group,women with SUI andⅠorⅡdegree prolapse of anterior vaginal wall by POP-Q and the control group,women without SUI or prolapse of vaginal wall,were investigated. Vaginal wall specimens were obtained during the vaginal delivery after lateral episiotomy. Tissues were detect by Masson stainning to compare the difference of elastin and collagen while expression level of fibulin-5 and TGF-βby immunohistochemistry. Results were analysed by Image-Pro Plus software and Student′s t-test as statistical method. Results:Expression of fibulin-5 were higher in the control group than in the study group (t=3.062,P=0.005),while TGF-βhad no statistical difference between them (t=1.670,P=0.098). Elastin and collagen were abnormal between the two groups by Masson staining,regular,intact in the control group while disorder,fracture in study group. Conclusions:The dysfunction of pelvic floor in pregnancy period may be caused by the decreased expression of elastin and fibulin-5 which is the crosslink factor of elastin.