医学信息
醫學信息
의학신식
MEDICAL INFORMATION
2014年
35期
97-99
,共3页
骶韧带%凋亡%成纤维细胞%结蛋白%盆腔器官脱垂%平滑肌细胞
骶韌帶%凋亡%成纖維細胞%結蛋白%盆腔器官脫垂%平滑肌細胞
저인대%조망%성섬유세포%결단백%분강기관탈수%평활기세포
Apoptosis%Fibroblasts%Desmin%Pelvic organ prolapse%Smooth muscle cel%Uterosacral ligament
背景盆腔器官脱垂(pelvic organ prolapse,POP)是一个世界性的卫生问题。多产、老年、肥胖、重体力劳动、肛提肌或神经损伤、慢性肺部疾患是POP发病的的高危因素,但确切的发病机制尚不明确。子宫骶韧带支撑着宫颈及上段阴道,其缺陷将引起子宫脱垂或阴道顶端脱垂。骶韧带组织结构决定着其韧性和抗张能力。目的本文旨在探讨女性POP患者骶韧带组织结构变化；比较骶韧带平滑肌细胞与成纤维细胞增殖、凋亡的差异,以了解骶韧带组织结构变化与POP发病的关系。方法①取10例POP患者和10例非POP患者的骶韧带,在光学显微镜下观察组织结构；②石蜡切片进行平滑肌细胞与成纤维细胞结蛋白(Desmin)、肌动蛋白(Actin)、波形蛋白(Vimentin)和Ki67免疫组织化学染色,分析非血管平滑肌细胞与成纤维细胞的分布比例；计算平滑肌细胞Desmin、平滑肌细胞与成纤维细胞Ki67平均光密度(OD)值,比较两组骶韧带非血管平滑肌细胞Desmin、平滑肌细胞与成纤维细胞Ki67的表达；③原位末端标记测定法(TUNEL法)检测非血管平滑肌细胞的凋亡,计算凋亡指数(AI)。结果①光学显微镜下发现骶韧带呈现不规则致密结缔组织的特征,主要由平滑肌细胞、成纤维细胞、血管、神经、脂肪构成；②POP患者骶韧带非血管平滑肌细胞的分布比例较非POP患者降低(0.26±0.08 vs.0.35±0.06,<0.05)；③POP患者非血管平滑肌细胞Desmin染色增强,失去正常带状结构,排列紊乱,或呈团状聚集于细胞浆中,或呈块状附于细胞膜下,散在排列于骶韧带内。POP患者骶韧中带非血管平滑肌细胞Desmin表达增强(0.28±0.06 vs.0.21±0.02,<0.05)；④两组非血管平滑肌细胞ki67均无明显表达,POP患者成纤维细胞Ki67表达增强(0.08±0.02 vs.0.02±0.02,<0.05)；⑤POP患者中骶韧带内非血管平滑肌凋亡指数较对照组明显升高(0.41±0.08 vs.0.11±0.04,<0.05),POP患者骶韧带内非血管平滑肌细胞凋亡增加。结论①平滑肌细胞在骶韧带组织中起主要支持作用,成纤维细胞和平滑肌细胞是骶韧带中最重要的两种功能细胞,其数量及功能的改变与POP的关系需进一步探讨；②骶韧带平滑肌细胞减少、Desmin表达异常、平滑肌细胞凋亡增加、成纤维细胞增殖参与了POP的发生、发展；③骶韧带平滑肌细胞减少可能与平滑肌细胞凋亡增加而增殖不明显有关。
揹景盆腔器官脫垂(pelvic organ prolapse,POP)是一箇世界性的衛生問題。多產、老年、肥胖、重體力勞動、肛提肌或神經損傷、慢性肺部疾患是POP髮病的的高危因素,但確切的髮病機製尚不明確。子宮骶韌帶支撐著宮頸及上段陰道,其缺陷將引起子宮脫垂或陰道頂耑脫垂。骶韌帶組織結構決定著其韌性和抗張能力。目的本文旨在探討女性POP患者骶韌帶組織結構變化；比較骶韌帶平滑肌細胞與成纖維細胞增殖、凋亡的差異,以瞭解骶韌帶組織結構變化與POP髮病的關繫。方法①取10例POP患者和10例非POP患者的骶韌帶,在光學顯微鏡下觀察組織結構；②石蠟切片進行平滑肌細胞與成纖維細胞結蛋白(Desmin)、肌動蛋白(Actin)、波形蛋白(Vimentin)和Ki67免疫組織化學染色,分析非血管平滑肌細胞與成纖維細胞的分佈比例；計算平滑肌細胞Desmin、平滑肌細胞與成纖維細胞Ki67平均光密度(OD)值,比較兩組骶韌帶非血管平滑肌細胞Desmin、平滑肌細胞與成纖維細胞Ki67的錶達；③原位末耑標記測定法(TUNEL法)檢測非血管平滑肌細胞的凋亡,計算凋亡指數(AI)。結果①光學顯微鏡下髮現骶韌帶呈現不規則緻密結締組織的特徵,主要由平滑肌細胞、成纖維細胞、血管、神經、脂肪構成；②POP患者骶韌帶非血管平滑肌細胞的分佈比例較非POP患者降低(0.26±0.08 vs.0.35±0.06,<0.05)；③POP患者非血管平滑肌細胞Desmin染色增彊,失去正常帶狀結構,排列紊亂,或呈糰狀聚集于細胞漿中,或呈塊狀附于細胞膜下,散在排列于骶韌帶內。POP患者骶韌中帶非血管平滑肌細胞Desmin錶達增彊(0.28±0.06 vs.0.21±0.02,<0.05)；④兩組非血管平滑肌細胞ki67均無明顯錶達,POP患者成纖維細胞Ki67錶達增彊(0.08±0.02 vs.0.02±0.02,<0.05)；⑤POP患者中骶韌帶內非血管平滑肌凋亡指數較對照組明顯升高(0.41±0.08 vs.0.11±0.04,<0.05),POP患者骶韌帶內非血管平滑肌細胞凋亡增加。結論①平滑肌細胞在骶韌帶組織中起主要支持作用,成纖維細胞和平滑肌細胞是骶韌帶中最重要的兩種功能細胞,其數量及功能的改變與POP的關繫需進一步探討；②骶韌帶平滑肌細胞減少、Desmin錶達異常、平滑肌細胞凋亡增加、成纖維細胞增殖參與瞭POP的髮生、髮展；③骶韌帶平滑肌細胞減少可能與平滑肌細胞凋亡增加而增殖不明顯有關。
배경분강기관탈수(pelvic organ prolapse,POP)시일개세계성적위생문제。다산、노년、비반、중체력노동、항제기혹신경손상、만성폐부질환시POP발병적적고위인소,단학절적발병궤제상불명학。자궁저인대지탱착궁경급상단음도,기결함장인기자궁탈수혹음도정단탈수。저인대조직결구결정착기인성화항장능력。목적본문지재탐토녀성POP환자저인대조직결구변화；비교저인대평활기세포여성섬유세포증식、조망적차이,이료해저인대조직결구변화여POP발병적관계。방법①취10례POP환자화10례비POP환자적저인대,재광학현미경하관찰조직결구；②석사절편진행평활기세포여성섬유세포결단백(Desmin)、기동단백(Actin)、파형단백(Vimentin)화Ki67면역조직화학염색,분석비혈관평활기세포여성섬유세포적분포비례；계산평활기세포Desmin、평활기세포여성섬유세포Ki67평균광밀도(OD)치,비교량조저인대비혈관평활기세포Desmin、평활기세포여성섬유세포Ki67적표체；③원위말단표기측정법(TUNEL법)검측비혈관평활기세포적조망,계산조망지수(AI)。결과①광학현미경하발현저인대정현불규칙치밀결체조직적특정,주요유평활기세포、성섬유세포、혈관、신경、지방구성；②POP환자저인대비혈관평활기세포적분포비례교비POP환자강저(0.26±0.08 vs.0.35±0.06,<0.05)；③POP환자비혈관평활기세포Desmin염색증강,실거정상대상결구,배렬문란,혹정단상취집우세포장중,혹정괴상부우세포막하,산재배렬우저인대내。POP환자저인중대비혈관평활기세포Desmin표체증강(0.28±0.06 vs.0.21±0.02,<0.05)；④량조비혈관평활기세포ki67균무명현표체,POP환자성섬유세포Ki67표체증강(0.08±0.02 vs.0.02±0.02,<0.05)；⑤POP환자중저인대내비혈관평활기조망지수교대조조명현승고(0.41±0.08 vs.0.11±0.04,<0.05),POP환자저인대내비혈관평활기세포조망증가。결론①평활기세포재저인대조직중기주요지지작용,성섬유세포화평활기세포시저인대중최중요적량충공능세포,기수량급공능적개변여POP적관계수진일보탐토；②저인대평활기세포감소、Desmin표체이상、평활기세포조망증가、성섬유세포증식삼여료POP적발생、발전；③저인대평활기세포감소가능여평활기세포조망증가이증식불명현유관。
Background Pelvic organ prolapse (POP)is a global health problem.Multiparity,old age,overweight,chronic straining and obstructive lung diseases are the most important risk factors.Despite the high incidence of POP,lit le is known about the underlying pathophysiolgy of POP.The uterosacral ligaments are an important part of the pelvic support system and establish,according to Delancy,the level 1 support to the cevix and the upper vagina.The histologic structure of the uterosacral ligaments is the key factors associated with its support function.Objective This study is to compare the structural components of the uterosacral ligaments (USL)in women with and without pelvic organ prolapse (POP),and to compare cel proliferation and apoptosis of smooth muscle cel s and fibroblasts. Methods USL were sampled in women with(n=10)or without(n=10)uterine prolapse undergoing hysterectomy.Smooth muscle and fibroblasts of the USL was studied by Desmin,Actin,Vimentin and Ki67 immunohistochemistry.Digital image analysis was used to determine the fractional area of smooth muscle and fibroblasts in the histologic cross sections.The mean optics density of Desmin and Ki67 stained areas in the paraf in sections were observed and calculated.Apoptosis was assessed by terminal deoxynucelotidyl-transferase-mediated dUTP nick-end-labeling method (TUNEL),and the apoptosis index of the smooth muscle was calculated.Results ①The light microscope showed the histomorphological character of USL was ir egular dense connective tissue,mainly consisting of smooth muscle,fibroblasts,blood vessel,nerve cel s and fat cel s. ②The fractional area of nonvascular smooth muscle in the USL of women with uterine prolapse was significantly decreased compared to women without prolapse([0.26±0.08,0.35±0.06], <0.05).③Desmin of smooth muscle and Ki67 of fibroblasts in the USL of women with uterine prolapse was significantly increased compared to women without prolapse respectively ([0.28±0.06,0.21±0.02],p<.05);([0.08±0.02,0.02±0.02], <0.05). ④The apoptotic index of smooth muscle in the USL of women with uterine prolapse was significantly higher compared to women without prolapse ([0.41±0.08,0.11±0.04], <0.05).Conclusion Smooth muscles are the main supporting substance in the USL.Smooth muscle cel s and fibroblasts are two important compositions in the USL.Decreased smooth muscle content of the USL likely due to increased apoptosis and cel proliferation of fibroblasts and abnormal expression of structure protein Desmin may play a role in the pathogenesis of POP.
