| ObjectiveTo investigate the contractility and contract potentiality of myometrium from postpartum hemorrhage parturient caused by uterine atony,study the expression and alteration of extracellular-signal regulated kinase1(ERKl/2)and c-jun N-terminal kinase(JNKl/2) and p38 in myometrium from them, research the variation of Connexin43(CX43) mRNA and the protein levels, discuss the change of contractility and potentiality of myometrium from postpartum hemorrhage parturient caused by uterine atony ,and to determin the significance of mitogen-activated protein kinase(MAPK) pathway and CX43 in the pathogenesis of postpartum hemorrhage(PPH),analyze the relationship between MAPK activation and CX43 levels.MethodsIsometric tension recording was used for 30 uterus smooth muscle samples in PPH patients of atony (cases: ruled out the PPH patients possibility occurs of retained placental fragments, genital tract trauma and coagulopathy)and 30 normal parturitions (controls:the period parturient without PPH)to detect the contractility and its potentiality induced by oxytocin.The levels of CX43,phosphorylation of ERK1,JNK1and p38MAPK in myometrium of cases and controls were determined by western blotting.ALL of tissues of cases and their controls were detected for the mRNA of CX43 by Real-time fluorescent quantitative reverse transcription PCR. Result1.The contractility of myometriums in the case group were significanctly lower than that of their controls(P<0.05),the differences were mainly caused by the frequency of constriction(P<0.05).2.To evaluate the postpartum hemorrhage of uterine atony by the diagnosis which constriction acitivity was 72.66 g·times an hour,the area under curve of ROC is 0.802,the insensitivity is 0.867 and the specificity was 0.700.3.The frequency and range of the constriction induced by oxytocin were significantly increased(P<0.01).The contract potentiality of uterine atony group was lower than that of their controls(P<0.05).4.In the uterine atony group,the expression of p-ERK1/2,p-JNK1/2 and p-P38 in myometrium were lower than that of their controls ( P <0.05),especially of the p-ERK1/2(P<0.01).5.There were positive correlation among the expression of p-ERK1/2,p-JNK1/2 and p-P38 (P<0.05).6. There were positive correlation between the expression of p-ERK1/2,p-JNK1/2,p-P38 and their contraction activities(P<0.05).7. In the uterine atony group,the expression of CX43mRNA and their protein levels in myometrium were lower than that of their controls(P<0.05).8.The CX43mRNA levels and its protein quantum were siginificantly correlated with the expression of p-ERK1/2,p-JNK1/2 and p-P38 in uterus smooth muscle(P<0.05).9. The CX43mRNA levels in myometrium were positively correlated with contraction activity(P<0.05).Also is the protein levels of CX43.Conclusion1.The contractility of atony PPH women were lower than that of the controls,it may mainly composed of the difference of frequency of constriction. 2.The constriction induced by oxytocin were significantly increased in both of the frequency and range.The contract potentiality induced by oxytocin of utrine atony samples were lower than that of the controls,may suggest that its reactivity to oxytocin were poor than that of the non-atony women.3.There were correlations among the activities of ERK1/2,JNK1/2,p38 and constriction,implied that the MAPK signal pathway can regulate the constriction of uterus smooth muscle.4.In the uterine atony group,the expression of p-ERK1/2,p-JNK1/2 and p-P38 in myometrium were lower than that of their controls,and there were correlations among the three pathways,hinted that the interruption of MAPK signal pathway activate, may correlated with and corporately join the development of PPH.5.The lower exprssion of CX43 in myometrium may play an important role in pathogenesis of PPH.6.The expression of CX43mRNA and its proteins were positively correlated with the level of p-ERK1/2,p-JNK1/2 and p-P38,suggested that the MAPK signal pathway may promote the role of CX43 in pathogenesis of PPH.
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