Relationship And Significance Of ER-α,β Subtype And P53Expression In Patients With Uterine Prolapse Of The Cardinal Ligament Tissue

Objective: The main ligament of the uterus is a pair of strong smoothmuscle and connective tissue fibers, support structure is important to preventthe uterus, play a major role in the fixed position of prolapse of the uterus,cervix.Its morphology, composition and regulation of gene expression changesmay cause uterine prolapse. This change may be related to pregnancy andvaginal delivery injury, long-term increase abdominal pressure, birth defects,and pelvic floor muscle degeneration. Estrogen receptor (ER-alpha, ER-beta)expression changes can lead to toughness and resistance to tension of the mainligament of the uterus. P53gene in normal circumstances plays an slow ormonitoring role in cell division, the p53gene regulatory change may lead torepair the damaged cells themselves weakened or even lost. This study onpatients with uterine prolapse (POP-Q stage II-IV) main ligament ER in localtissue-alpha, beta and ER-P53expression level testing and correlationanalysis, this paper expounds the main ligament morphology, composition andthe change of gene expression regulation and the relationship between uterineprolapse.Methods:1Research object: select2012January-2012year in June in HebeiGeneral Hospital maternity a Coyne uterine prolapse (POP-Q stage II-IV)underwent operation treatment of32patients as the experimental group, theexperimental group was divided into2groups: premenopausal uterineprolapse were14cases,18cases of postmenopausal uterine prolapse patients,among premenopausal uterine1cases of uterine prolapse group contains IIprolapse and stress urinary incontinence (stress urinary incontinence,SUI).Selected at the same time no pelvic organ prolapse (pelvic outraged prolapse, POP) and without stress urinary incontinence (SUI) need to line theuterus cut of all31cases as control group, patients with the control group weredivided into2groups:17cases of premenopausal control group, control group14after menopause.2Experimental methods: the experimental group and the control grouptreated with the operation of all the way for vaginal or abdominalhysterectomy, in operation in tissue resection and cardinal ligament of uterustissue close to the cervix, about the size of1cm×1cm×1cm, the tissuesections confirmed ligament tissue staining for HE.Usingimmunohistochemical method (SP method) to detect the expression of ER-α,main ligament tissues of ER-β and P53, the intensity of expression byimmunohistochemical score (IHS) said.3All data using SPSS13.0software for statistical data analysis.With age, body mass index (mean±standard deviation), the transvaginalproduction does not conform to normal distribution, expressed in percentile,mean comparisons between groups with single factor analysis of variance, thesample rate compared with chi-square test;Correlation test by using Spearman rank and inspection are analyzed. Variousinspection methods for P=0.05level of significance.Results:1the histologic findings of the main ligament: before and aftermenopause uterine prolapse patients the main ligament tissue collagen fibercontent decreased, and loss of normal order, the visible part of the collagenfiber fracture; Smooth muscle bundle of gap width, disordered arrangement,visible part of the different degree of deformation, such as vacuoles change,amyloidosis and cell edema, etc.2main ligament tissue expression of ER-α: ER-α is given priority towith smooth muscle cells and fibroblasts cell nucleus expression,postmenopausal uterine prolapse group and the control group before thedetermination of ER-α value respectively:(17.29+7.82)%,(29.71+7.14)%.Positive rate respectively:28.57%,70.59%. Premenopausal women with uterine prolapse group and control group in the determination of ER-α valueswere significantly different (P <0.001); premenopausal uterine prolapsegroup and the positive rate of ER-α in the control group had significantdifference (P=0.032).Postmenopausal uterine prolapse group and the determination of controlgroup ER-alpha values were:(18.94±10.37)%,(27.79±6.99)%. Thepositive rates were:27.78%,64.29%.Postmenopausal uterine prolapse groupand the control group of ER alpha measurements have significant difference(P=0.007); Postmenopausal uterine prolapse positive rate of ER alpha groupand control group with significant difference (P=0.018).3main ligament tissue expression of ER-beta: ER-beta expression insome tissue biopsies, postmenopausal uterine prolapse group and the controlgroup before the ER-beta measurements respectively:(11.79+5.89)%,(12.59+5.20)%. Positive rate respectively:21.42%,64.71%.Premenopausal women with uterine prolapse group and control group ER-beta value was no significant difference (P=0.691); premenopausal uterineprolapse group and the positive rate of group ER-beta had significantdifferences (P=0.029).Postmenopausal uterine prolapse group and the control group of ER-beta measurements respectively:(10.22+4.68)%,(12.29+5.10)%. Positiverate respectively:16.67%,57.14%. Postmenopausal uterine prolapse groupand control group in the ER-determination of the beta value has nosignificant difference (P=0.242); Postmenopausal uterine prolapse group andthe control group of ER-beta positive rate have significant difference (P=0.027).4P53expression in four main ligament tissue: P53expression in mosttissue biopsies, postmenopausal uterine prolapse group and the control groupbefore the determination value of P53is respectively:(7.78+2.89)%,(23.53+10.83)%. The positive rates respectively were:14.29%,58.82%.Premenopausal women with uterine prolapse and determination of P53ofcontrol group were significantly different (P <0.001); premenopausal uterine prolapse group and the positive rate of P53in the control group had significantdifference (P=0.024).Postmenopausal uterine prolapse group and the control group of P53measurements respectively:(9+4.31)%,(17.57+7.09)%. Positive raterespectively:5.56%,42.86%. Postmenopausal uterine prolapse determinationvalue of P53, significant differences with the control group (P <0.001);Postmenopausal uterine prolapse group, positive rate of P53had significantdifference with control group (P=0.027).5The relationship between P53and ER-α, ER-β expression: Spearmanrank sum test statistics: premenopausal prolapse group compared with thecontrol group, the expression level of P53and ER-α expression levels have apositive correlation (P=0.005), while the expression level of ER-β and alsohad a positive correlation (P=0.001);Postmenopausal prolapse groupcompared with control group, the P53expression level with ER-alphaexpression level has a positive correlation (P=0.002), at the same time withER-beta expression level also has a positive correlation (P=0.003).Conclusion:1before and after menopause uterine prolapse in the correspondingcontrol group collagen fiber content is lower, disordered arrangement;Smooth muscle bundle of gap width and part of the amyloidosis, etc. Suggestreducing the number of collagen fibers, crosslinking structure changes, mayreduce the toughness and elasticity of the main ligament, increased theoccurrence of uterine prolapse.2Before and after menopause uterine prolapse in the correspondingcontrol group determination of ER-alpha value and positive rate weresignificantly lower; Group before and after menopause uterine prolapse is ER-beta measurements corresponding control group no significant change, butthe positive rate significantly reduced.Prompts estrogen and estrogen receptors may strengthen the pelvic floorsupport structure of the tension, the expression of estrogen receptor mayparticipate in the uterine prolaps. 3Before and after menopause uterine prolapse group and positive rate ofP53, corresponding control measurements were significantly reduced, promptafter the lack of P53may reduce the ligament tissue damage repair ability,increase the risk of uterine prolapse.4P53expression and correlated with ER-alpha, ER-beta expressionand P53expression intensity and intensity of ER alpha, ER-beta expressionconsistent, speculated that the role of P53expression in tissue injury afterrepair may be associated with estrogen receptor.