上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (5): 610-.doi: 10.3969/j.issn.1674-8115.2011.05.018

• 论著（临床研究） • 上一篇    下一篇

妊娠晚期雌、孕激素及其受体表达与压力性尿失禁的关系

吴氢凯1, 毛笑园1, 姜 丽1, 冯 洁1, 罗来敏1, 惠 宁2   

  1. 1.上海交通大学附属第六人民医院妇产科, 上海 200233； 2.第二军医大学附属长海医院妇产科, 上海 200433
  • 出版日期:2011-05-28 发布日期:2011-05-27
  • 作者简介:吴氢凯（1966—）, 女, 主任医师, 硕士；电子信箱: angelh2@163.com。
  • 基金资助:

    上海市卫生局科研基金（2006057）

Correlation of serum estrogen and progesterone levels and expression of estrogen and progesterone receptors with stress urinary incontinence in late pregnancy

WU Qing-kai1, MAO Xiao-yuan1, JIANG Li1, FENG Jie1, LUO Lai-min1, HUI Ning2   

  1. 1.Department of Obstetrics and Gynecology, the Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China；2.Department of Obstetrics and Gynecology, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China
  • Online:2011-05-28 Published:2011-05-27
  • Supported by:

    Shanghai Municipal Health Bureau Foundation, 2006057

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摘要：

目的 研究妊娠晚期血清雌、孕激素水平及盆底组织雌、孕激素受体表达与压力性尿失禁（SUI）的关系。方法 将阴道分娩的初产妇女71例分为SUI组（n=33）和非SUI组（n=38），于孕36～40周检测血清雌二醇（E2）、雌三醇（E3）、孕酮（P）水平。SUI组中的20例和非SUI组中的31例于胎儿娩出后，取会阴侧切口顶端最深部肌肉组织行病理组织学和超微结构观察,选取3例因外阴癌、直肠癌行手术治疗的女性非妊娠患者作为对照。采用免疫组织化学方法检测盆底组织雌激素受体（ER）和孕激素受体（PR）表达。结果 SUI组与非SUI组孕妇血清E2和E3水平比较，差异均无统计学意义（P＞0.05）；SUI组孕妇血清P的质量浓度小于非SUI组\[（184.7±48.2）μg/L和（223.2±93.5）μg/L\]（P＜0.05）。病理组织学及超微结构观察均发现，妊娠晚期妇女会阴深部平滑肌细胞有不同程度的空泡变性，肌纤维变细，细胞间质水肿。非SUI组平滑肌细胞ER和PR的强阳性表达率均显著高于SUI组（P<0.05）；盆底横纹肌细胞不表达ER和PR。结论 雌激素和孕激素对妊娠期盆底结构和功能均起到保护作用。

关键词: 妊娠, 压力性尿失禁, 雌激素, 孕激素, 受体

Abstract:

Objective To investigate the correlation of serum estrogen and progesterone levels and expression of estrogen and progesterone receptors in pelvic floor tissues with stress urinary incontinence (SUI) in late pregnancy. Methods Seventy-one pregnant primiparas undergoing vaginal delivery were divided into SUI group (n=33) and non-SUI group (n=38), and serum levels of estradiol (E2), estriol (E3) and progesterone (P) were detected at gestational week 36 to 40. Muscular tissue samples were obtained from the top of lateral incision of perineum from 20 cases in SUI group and 31 cases in non-SUI group after delivery, and pathohistological and ultrastructure observations were performed. Another 3 nonpregnant female patients with carcinoma of vulva or rectum cancer undergoing surgery were served as controls. The expression of estrogen receptor and progesterone receptor in pelvic floor tissues was detected by immunohistochemical staining. Results There was no significant difference in serum E2 and E3 between SUI group and non-SUI group (P＞0.05). The serum mass concentration of P in SUI group was significantly lower than that in non-SUI group [（184.7±48.2）μg/L vs （223.2±93.5）μg/L]（P＜0.05）. Pathohistological and ultrastructure observations revealed that there were vacuolar degeneration, filament alteration and edema in smooth muscle cells of deep pelvic floor. The expression of estrogen receptor and progesterone receptor in smooth muscle cells in non-SUI group was significantly higher than that in SUI group (P<0.05). There was no expression of estrogen receptor and progesterone receptor in skeletal muscle cells of pelvic floor. Conclusion Both estrogen and progesterone may protect the structure and function of pelvic floor in pregnant primiparas.

Key words: pregnancy, stress urinary incontinence, estrogen, progesterone, receptor