雌、孕激素及松弛素的相互作用与妊娠期压力性尿失禁的相关性研究

目的 探讨妊娠晚期雌激素、孕激素、松弛素(RLX)及阴道壁各激素受体表达水平与妊娠期压力性尿失禁(SUI)的关系.方法 将2014年7月至2015年11月健康孕产妇93例(包括SUI组47例,非SUI组46例),于孕37～40周时抽血,应用化学发光免疫分析法检测血清雌二醇(E2)、雌三醇(E3)和孕酮(P)水平,酶联免疫吸附测定(ELISA)检测血清RLX水平;SUI组中42例和非SUI组中44例于其分娩时取阴道后壁全层组织,行免疫组织化学法染色测定盆底组织中雌激素受体(ER)、孕激素受体(PR)及RLX受体(LGR7)的表达.结果 SUI组与非SUI组孕妇血清E2、E3、P水平比较,差异均无统计学意义(P＞0.05);SUI组孕妇血清RLX水平明显高于非SUI组(P＜0.05).SUI组盆底组织ER的阳性表达强度低于非SUI组,SUI组盆底组织PR、LGR7的阳性表达强度高于非SUI组,差异均有统计学意义(P＜0.05).孕妇血清RLX水平和盆底组织中LGR7的表达与E2、E3、P均无相关性(P＞0.05);盆底组织中LGR7与ER无相关性,与PR呈正相关.结论 妊娠晚期雌激素、孕激素、RLX对盆底支持组织的生物活性由其受体表达的水平介导发挥;PR可能对LGR7有正性调节作用,其与妊娠期SUI的发生密切相关.

Study on relationship between interaction of estrogen,progesterone and relaxin with stress urinary incontinence during pregnancy

Objective To study the relationship between the expression levels of estrogen,progesterone,relaxin(RLX) and expression levels of vaginal wall hormone receptors in late pregnancy with stress urinary incontinence(SUI) during pregnancy.Methods Ninety-three healthy pregnant women were selected from July 2014 to November 2015,including 47 cases in the SUI group and 46 cases in the non-SUI group.The blood sample was collected at 37-40 weeks gestation.The levels of serum E2,E3,P and RLX were respectively detected by using the chemiluminescence immunoassay and enzyme linked immunosorbent assay(ELISA).The full thickness tissues of posterior vaginal wall were obtained at delivery in 42 cases of the SUI group and 44 cases of the non-SUI group,and the expressions of ER,PR and LGR7 in pelvic floor tissues were detected by immunohistochemical staining.Results There was no statistically significant difference in serum E2,E3 and P levels between the SUI group and the non-SUI group(P＞0.05);the serum RLX level of the SUI group was significantly higher than that of the non-SUI group(P＜0.05).The positive expression intensity of ER in pelvic floor tissue of the SUI group was lower than that of the non-SUI group(P＜0.05),the positive expression intensity of PR and LGR7 in the SUI group was higher than that in the non-SUI group(P＜0.05).The serum RLX level and expression of LGR7 in pelvic floor tissues of pregnant women had no correlation with E2,E3 and P(P＞0.05).The LGR7 level in pelvic floor tissues had no correlation with ER,and was positively correlated with PR.Conclusion In late pregnancy,the biological activity of estrogen,progesterone and RLX on pelvic floor support tissues is mediated by their receptors expression levels,the progesterone receptor may have a positive regulation effect on LGR7,which is closely related to the occurrence of SUI in pregnancy.