压力性尿失禁的病因学研究

目的　绝经后压力性尿失禁 (SUI)患者补充雌激素的临床疗效尚有争议。本研究通过对血雌二醇 (E2 )浓度及子宫韧带的雌激素受体 (ER)的观察 ,分析雌激素与SUI和盆底组织膨出 (POP)发生的关系。方法　绝经前、后对照组、POP组和绝经后SUI组共 5组 73例子宫全切患者 ,免疫组化方法测定主韧带、宫骶韧带ER含量。结果　 ( 1)绝经前POP组血E2 浓度 ( 4 7.2 9pg ml± 38.30pg ml)、韧带ER值明显低于绝经前对照组 (E2 73.83pg ml± 5 2 .72pg ml;ER主韧带9.5 8%± 2 .39% ,ER宫骶韧带11.6 4 %±2 .6 8% ) ,差异非常显著 (P <0 .0 1)。 ( 2 )绝经后韧带ER值 :对照组 (ER主韧带10 .89%± 2 .5 4 % ,ER宫骶韧带13.0 9%± 3.0 3% )、POP组 (ER主韧带11.85 %± 2 .89% ,ER宫骶韧带13.2 1%± 3.4 6 % )及SUI组 (ER主韧带9.6 4 %± 5 .0 1% ,ER宫骶韧带11.12 %± 6 .13% )之间无显著差异 ( P >0 .0 5 )。 ( 3)绝经前、后对照组韧带ER值无显著差异 (P >0 .0 5 )。绝经前对照组月经增生期、分泌期韧带ER值无显著差异 (P >0 .0 5 )。血E2 浓度与韧带ER值无相关性。 ( 4 )绝经后对照组绝经时间与主韧带ER值成正相关 ,与宫骶韧带ER值无相关性。绝经后POP组和SUI组主韧带、宫骶韧带ER值与绝经时间成正相关。 ( 5 )各组研究对?

The etiological study of stress urinary incontinence

Objective To observe the estrogen receptor (ER) status in the uterine ligaments and to investigate the relationship between estrogen and stress urinary incontinence (SUI) as well as pelvic organ prolapse (POP).Methods The cardinal and uterosacral ligament samples were obtained from 73 patients undergoing hysterectomy.The ERs in cardinal and uterosacral ligament were detected by immunohistochemical staining.Results The levels of serum estradiol and ERs in the uterine ligaments in premenopausal women with POP were significantly lower than those in control group (P<0.01).There was no significant difference in ERs value among the postmenopausal SUI,POP and control groups (P>0.05).But a positive correlation was found between ERs and postmenopausal years(P<0.01).There was no significant difference in ERs levels between the follicular and luteal phases or between premenopausal and postmenopausal women(P>0.05).Histological characteristics and ERs value of the cardinal and uterosacral ligaments were similar.Conclusion (1)Deficiency of estrogen and ERs may play a role in premenopausal SUI and postmenopausal years.So further research is needed to elucidate whether hormone replacement therapy (HRT) is useful in the treatment of SUI and POP.(2)ERs expression in the uterine ligaments is not related to menstrual cycle and menopausal status.(3)The cardinal and uterosacral ligaments are homologous.