中国医科大学学报

中国医科大学学报

中国医科大学学报 ›› 2016, Vol. 45 ›› Issue (9): 777–782.doi: 10.12007/j.issn.0258-4646.2016.09.003

• 论著 • 上一篇    下一篇

TGF-β1 和 VEGF 在子宫瘢痕中的表达及其与子宫瘢痕愈合的关系

段薇 1,2,于月新 1   

  1. 1 中国人民解放军第 202 医院全军优生优育及计划生育技术研究所,沈阳 110003;2 大连医科大学研究生院,辽宁 大连 116000
  • 收稿日期:2016-05-30 出版日期:2016-09-28 发布日期:2016-08-29
  • 通讯作者: 于月新 E-mail:yuyuexinpingan@163.com
  • 作者简介:段薇(1989 -),女,硕士研究生 .
  • 基金资助:

    辽宁省科学技术计划(2013225089)

Expressions of Transforming Growth Factor β1 and Vascular Endothelial Growth Factor in Uterine Scar and Their Relationship with Scar Healing

DUAN Wei1,2,YU Yuexin1   

  1. 1 The Eugenics and Family Planning Research Institute of Chinese People′s Liberation Army 202 Hospital,Shenyang 110003,China;2 Graduate School,DalianMedical University,Dalian 116000,China
  • Received:2016-05-30 Online:2016-09-28 Published:2016-08-29

摘要:

目的 通过检测转化生长因子 β1(TGF-β1)和血管内皮生长因子(VEGF)在子宫瘢痕部位的表达,结合剖宫产术后不同 时期子宫瘢痕愈合情况,探讨子宫瘢痕部位愈合的病理机制。方法 选取前次剖宫产术后再次妊娠分娩孕妇 145 例作为研究 对象,按剖宫产术后再次妊娠间隔时间分为 5 组,对剖宫产术后不同时期子宫瘢痕部位愈合情况进行相关分析,取子宫瘢痕部 位组织行 HE 染色,采用 SP 免疫组化法检测 TGF-β1 和 VEGF 在不同时期子宫瘢痕部位的表达。结果 145 例研究对象中子宫 瘢痕愈合良好者 115 例,愈合不良者 30 例。剖宫产术后 2~<4 年组瘢痕部位愈合不良发生率为 6.7%,与其他组比较明显降低(P < 0.05)。HE 染色示正常子宫肌层由成片状的平滑肌组织构成,其间有少许结缔组织;剖宫产术后<2 年组切口瘢痕部位主 要有肉芽组织、胶原纤维构成;剖宫产术后 2~<4 年组子宫瘢痕部位可见胶原纤维及少量分化的平滑肌组织,伴少量的炎性细 胞;剖宫产术后 4~<6 年组子宫瘢痕肌层可见纤维母细胞,胶原纤维束增多;剖宫产术后 6~<8 年组平滑肌变性,大量胶原纤维 束;剖宫产术后≥8 年组胶原纤维形态紊乱,微血管增生。SP 免疫组化法结果显示,与对照组相比,剖宫产术后<2 年组与剖宫产 术后≥8 年组 TGF-β1 和 VEGF 表达均增高(P < 0.05),但 2 组比较 TGF-β1 和 VEGF 表达的差异无统计学意义(P > 0.05)。剖宫产 术后 2~<4 年组 TGF-β1 和 VEGF 表达量均减少,与其他 4 组比较差异均有统计学意义(P < 0.05)。剖宫产术后 2~<4 年组 TGF-β1 和 VEGF 的表达量最少,与对照组比较差异均无统计学意义(P > 0.05)。TGF-β1 与 VEGF 表达呈正相关(r = 0.758,P < 0.01)。 结论 TGF-β1 和 VEGF 在子宫瘢痕肌层愈合过程中起重要作用,可促进瘢痕部位的愈合及修复,但过表达不利于瘢痕愈合。 剖宫产术后 2~4 年胶原纤维成分与平滑肌组织处于相对稳定状态,胶原纤维肌肉化程度最佳,是子宫切口愈合的最佳时期,即 发生子宫破裂风险相对最小。随着时间延长,TGF-β1 和 VEGF 表达持续增加,且相互协同作用,使瘢痕部位老化及瘢痕过度增 生,子宫脆性逐渐增加,子宫破裂发生率随之升高。

关键词: 子宫, 瘢痕, 愈合, 转化生长因子 β1, 血管内皮生长因子

Abstract:

Objective To investigate the healing mechanism in uterine scar through the expressions of transforming growth factor β1(TGF-β1) and vascular endothelial growth factor(VEGF)in uterine scar and the uterine scar healing situation after cesarean section at different times.Methods A total of 145 pregnant women who experienced previous cesarean section were selected.,and divided into five groups according to the period of repeated pregnancy after cesarean section. The uterine scar healing situation after cesarean section at different times was analyzed. The expressions of TGF-β1 and VEGF in uterine scar at different times was detected by using SP immunohistochemistry method and HE staining. Results Among the 145 cases,115 cases were well healing,while 30 cases were bad healing. The incidence of bad healing was 6.7% in the 2-<4 years group,which was significantly lower than that of the other groups(P < 0.05). HE staining showed that the normal myometrium consisted of smooth muscle tissue and a little connective tissue. The cesarean scar tissue mainly consisted of granulation tissue and collagen fibers in <2 years group. In the 2-<4 years group,it could be seen smooth muscle tissue and a little inflammatory cells. The fibroblasts and collagen fibers increased in the uterine scar of the 4-<6 years group. The smooth muscle had degenerated and a large number of collagen fibers could be seen in the 6-<8 years group.In the ≥8 years group,collagen fiber arranged disorderly. SP immunohistochemical method results showed that,compared with the control group,the expressions of TGF-β1 and VEGF in <2 years group and ≥8 years group were increased(P < 0.05),but there were no significant differences between these two groups(P > 0.05). Compared with other groups,the expressions of TGF-β1 and VEGF in 2-<4 years group were significantly reduced,and the differences were statistically significant(P < 0.05). The expressions of TGF-β1 and VEGF in 2-<4 years were the least,and had no difference compared with the control group(P > 0.05). TGF- β1 and VEGF were positively correlated(r = 0.758,P < 0.01). Conclusion TGF- β1 and VEGF play an important role in the healing process of the myometriumas,and they can promote scar healing and repairing. But if they are over-expressed,it will not be conducive to wound healing. Collagen fibers and smooth muscle tissue are in a relatively stable state in 2-4 years,as the degree of muscle in the collagen fibers remains in the best condition,we can infer that the 2-4 years is the best time for uterine incision healing,with relatively minimal risk of uterine rupture. With time going by,the expressions of TGF-β1 and VEGF continue to increase. The scar is aging and proliferating,because of their mutual synergies,and the fragility of uterine gradually increases which can increase the rate of uterine rupture.

Key words: uterine, scar, heal, transforming growth factor β1, vascular endothelial growth factor

中图分类号: 

  • R714
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